Evaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patients
Abstract Background In spite of the improvement of many aspects around Total knee arthroplasty (TKA), there is still a group of 10% to 34% of patients who is not satisfied with the outcome. The therapy of chronic pain after TKA remains a medical challenge that requires an interdisciplinary therapy c...
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doaj-c48267c84f6548aabfee1b4c685daa9c2020-11-25T01:31:17ZengBMCPatient Safety in Surgery1754-94932017-08-0111111010.1186/s13037-017-0137-xEvaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patientsDirk Zajonz0Johannes K. M. Fakler1Anna-Judith Dahse2Fujiaoshou Junping Zhao3Melanie Edel4Christoph Josten5Andreas Roth6Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital LeipzigDepartment of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital LeipzigPharmacy of the University Hospital LeipzigClinic for Anesthesiology and Intensive Therapy, University Hospital LeipzigDepartment of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital LeipzigDepartment of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital LeipzigDepartment of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital LeipzigAbstract Background In spite of the improvement of many aspects around Total knee arthroplasty (TKA), there is still a group of 10% to 34% of patients who is not satisfied with the outcome. The therapy of chronic pain after TKA remains a medical challenge that requires an interdisciplinary therapy concept. The aim of this prospective pilot study was to evaluate the efficacy of a multimodal pain therapy in chronic complaints after TKA. Methods In a prospective cohort pilot study, we included patients with chronic pain after TKA who obtained in-patient care, especially multimodal pain therapy (MMPT), for at least 10 days. Essential elements of this therapy concept were physiotherapy, pain medication therapy, topical application of ketamine, local infiltration and Traditional Chinese Medicine. Patients with varying causes of complaints were excluded in advance. Before the start of the study all test persons were informed and gave their written consent. Moreover, each patient was examined and questioned at hospital admission, discharge and at its first as well as second follow-up. Additionally, knee joint mobility and stability were investigated at all examination times. Results From 03/07/2016 to 07/14/2016, 21 patients were included in the pilot study. 52% of the considered population were female (11 persons). The median age was 65 years (45–79 years) and the median stay in hospital amounted 9 days (8–14 days). The first follow-up was scheduled after six weeks (median: 38 days, 30–112 days) and the second one after six months (median: 8 months, 7–12 months). The number of patients of the first follow-up was 17 out of 21 (19% drop out). The drop out of the last follow-up accounted for 33%. All patients benefit from the presented applications and therapies with regard to pain, function and range of motion. Especially, during the period of in-patient treatment, nearly all patients have improved in all terms. However, during the first follow-up clear deteriorations occurred in all areas, which stagnated up to the second follow-up. The range of motion has even worsened slightly. Conclusions With the presented pilot study on multimodal in-patient therapy of chronic complaints due to TKA, the improvement of pain, function and mobility could be verified, especially during the stationary stay. Even though the results deteriorate during the follow-up period, they did never relapse to their initial level. In order to ensure an effective treatment, a clear diagnostic algorithm is essential, by which treatable causes, such as low-grade infections or loosenings, are safely excluded. Further prospective studies are necessary to obtain precise statements on prospects of success of our therapy plan.http://link.springer.com/article/10.1186/s13037-017-0137-xArthrofibrosisMultimodal pain therapyTotal knee arthroplastyKetamineTraditional Chinese medicine |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Dirk Zajonz Johannes K. M. Fakler Anna-Judith Dahse Fujiaoshou Junping Zhao Melanie Edel Christoph Josten Andreas Roth |
spellingShingle |
Dirk Zajonz Johannes K. M. Fakler Anna-Judith Dahse Fujiaoshou Junping Zhao Melanie Edel Christoph Josten Andreas Roth Evaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patients Patient Safety in Surgery Arthrofibrosis Multimodal pain therapy Total knee arthroplasty Ketamine Traditional Chinese medicine |
author_facet |
Dirk Zajonz Johannes K. M. Fakler Anna-Judith Dahse Fujiaoshou Junping Zhao Melanie Edel Christoph Josten Andreas Roth |
author_sort |
Dirk Zajonz |
title |
Evaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patients |
title_short |
Evaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patients |
title_full |
Evaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patients |
title_fullStr |
Evaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patients |
title_full_unstemmed |
Evaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patients |
title_sort |
evaluation of a multimodal pain therapy concept for chronic pain after total knee arthroplasty: a pilot study in 21 patients |
publisher |
BMC |
series |
Patient Safety in Surgery |
issn |
1754-9493 |
publishDate |
2017-08-01 |
description |
Abstract Background In spite of the improvement of many aspects around Total knee arthroplasty (TKA), there is still a group of 10% to 34% of patients who is not satisfied with the outcome. The therapy of chronic pain after TKA remains a medical challenge that requires an interdisciplinary therapy concept. The aim of this prospective pilot study was to evaluate the efficacy of a multimodal pain therapy in chronic complaints after TKA. Methods In a prospective cohort pilot study, we included patients with chronic pain after TKA who obtained in-patient care, especially multimodal pain therapy (MMPT), for at least 10 days. Essential elements of this therapy concept were physiotherapy, pain medication therapy, topical application of ketamine, local infiltration and Traditional Chinese Medicine. Patients with varying causes of complaints were excluded in advance. Before the start of the study all test persons were informed and gave their written consent. Moreover, each patient was examined and questioned at hospital admission, discharge and at its first as well as second follow-up. Additionally, knee joint mobility and stability were investigated at all examination times. Results From 03/07/2016 to 07/14/2016, 21 patients were included in the pilot study. 52% of the considered population were female (11 persons). The median age was 65 years (45–79 years) and the median stay in hospital amounted 9 days (8–14 days). The first follow-up was scheduled after six weeks (median: 38 days, 30–112 days) and the second one after six months (median: 8 months, 7–12 months). The number of patients of the first follow-up was 17 out of 21 (19% drop out). The drop out of the last follow-up accounted for 33%. All patients benefit from the presented applications and therapies with regard to pain, function and range of motion. Especially, during the period of in-patient treatment, nearly all patients have improved in all terms. However, during the first follow-up clear deteriorations occurred in all areas, which stagnated up to the second follow-up. The range of motion has even worsened slightly. Conclusions With the presented pilot study on multimodal in-patient therapy of chronic complaints due to TKA, the improvement of pain, function and mobility could be verified, especially during the stationary stay. Even though the results deteriorate during the follow-up period, they did never relapse to their initial level. In order to ensure an effective treatment, a clear diagnostic algorithm is essential, by which treatable causes, such as low-grade infections or loosenings, are safely excluded. Further prospective studies are necessary to obtain precise statements on prospects of success of our therapy plan. |
topic |
Arthrofibrosis Multimodal pain therapy Total knee arthroplasty Ketamine Traditional Chinese medicine |
url |
http://link.springer.com/article/10.1186/s13037-017-0137-x |
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