Pressure Pain Threshold as a Predictor of Acute Postoperative Pain Following Total Joint Arthroplasty
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Abstract: Objectives: Acute pain in the postoperative period after total joint arthroplasty (TJA) has a significant effect on early rehabilitation, hospital length of stay, and the development of chronic pain. Consequently, efforts have been made to predict the occurrence of postoperative pain using preoperative and intraoperative factors. In this study, we tested the usefulness of preoperative pressure pain threshold (PPT) values in the prediction of three outcomes for patients who underwent TJA: visual analog scale pain scores, hospital length of stay, and opioid consumption. Materials and Methods: Using a digital pressure algometer, we measured the preoperative PPT in 41 patients expected to undergo TJA at three different body sites: the first web space of the hand, the operative joint, and the contralateral joint. We correlated each PPT separately with postoperative visual analog scale pain scores, hospital length of stay, and opioid consumption. Results: No significant correlation was found between preoperative PPT and the three postoperative outcomes. This finding held true when patients were subdivided by surgery type (total knee arthroplasty vs. total hip arthroplasty). There was no significant difference in PPT between the three body testing sites. Discussion: This study failed to prove the usefulness of PPT in the prediction of acute postoperative pain, pain medication consumption, and length of stay. The pressure algometer has previously found a place in the assessment of pain in a variety of clinical settings, but its utility has not yet been demonstrated in patients undergoing TJA. Authors: Brandon A. Haghverdian, BSc, Medical Student, Department of Orthopaedic Surgery, University of California, Irvine School of Medicine, Irvine, CA, David J. Wright, MD, MSc, Resident Physician, Department of Orthopaedic Surgery, University of California, Irvine School of Medicine, Irvine, CA, Ran Schwarzkopf, MD, MSc, Assistant Professor, Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital, for Joint Diseases, New York, NY |
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