Post-operative pain management in patients undergoing total knee arthroplasty: A literature review

Abstract

INTRODUCTION: Total knee arthroplasty (TKA) is one of the most effective treatment options for patients with severe knee osteoarthritis; however, this procedure is known to cause significant post-operative pain. Prolonged post-operative pain can predispose individuals to a prolonged and complex recovery. Managing variable responses to pain post TKA proves to be a significant challenge for both providers and patients. The purpose of this review is to investigate optimal pain management strategies for patients following TKA. METHODS: A literature search was conducted and included the following databases Medline, CINHAL, Cochrane library. Search terms or related terms included total knee arthroplasty, joint arthroplasty, opioids, post-operative, pain management, pain. Articles were then identified and reviewed based on relevance, type of study, and age of the study. RESULTS: Seven adjunctive pain management therapies were identified and include: Cox-2 specific inhibitors, Tylenol® , ketamine, corticosteroids, gabapentinoids, peri- and intra-articular knee injections, and physical therapy. Articles found concluded that therapies effective for reducing postoperative TKA pain included: Cox-2 specific inhibitors, Tylenol®, ketamine, corticosteroids, peri- and intra-articular knee injections. Therapies that reduced opioid consumption acutely in the TKA post-operative setting included Cox-2 specific inhibitors, Tylenol®, ketamine, gabapentinoids, peri- and intra-articular knee injections. Preoperative physical therapy did not decrease pain scores in the TKA postoperative setting. CONCLUSION: A multimodal treatment strategy is the most effective for reducing post-operative pain following TKA. This technique should include utilizing Cox-2 inhibitors, Tylenol®, ketamine, corticosteroids, gabapentinoids, peri- and intra-articular injections tailored to each individual patient.