Function and Pain Following Knee Replacement

Study Overview
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Brief Summary
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The goal of this interventional study is to compare pain management techniques (femoral nerve block, intra-articular block, none) in TKA patients. The main questions it aims to answer are: Are there differences in postoperative outcomes? Does preoperative quadriceps muscle strength predict early functional ability? Participants underwent TKA and assessments. Researchers compared pain management techniques to assess effects on postoperative outcomes and identified the importance of preoperative quadriceps muscle strength as a predictor of early functional ability. Further research is required to refine postoperative pain management strategies.

Detailed Description
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Total knee arthroplasty (TKA) is a frequently undertaken elective orthopedic intervention for severe knee osteoarthritis, frequently yielding postoperative discomfort and complications. Peripheral nerve blocks, notably femoral nerve blocks, are commonly utilized for analgesia but may transiently impede motor nerve function, weakening the quadriceps muscle. Intra-articular blocks offer a potential alternative to mitigate motor impairment. However, there exists a dearth of information regarding the comparative effectiveness of these methods with respect to short-term functional outcomes in the immediate postoperative phase following TKA. Objectives: This study assesses functional outcomes, pain, quadriceps strength after TKA with femoral nerve block, intra-articular block, and a control group. It identifies predictors of postoperative functional ability. Methods: 54 patients undergoing TKA were evaluated, measuring pre-op quadriceps strength, and utilizing the Oxford Knee Score for functionality. Post-op, we evaluated mobility using the Timed Up & Go, Elderly Mobility Scale, and Five Times Sit-to-Stand tests on POD 1 & 3/4. Pain levels, hospitalization, surgical duration, complications, and falls were also recorded.

Official Title
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Comparison of Function and Pain Intensity in the Acute Stage Following Total Knee Replacement, Between Different Methods of Post-surgical Pain Relief

Conditions
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Knee Arthropathy, Post Operative Pain, Pain, Postoperative

Intervention / Treatment
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* Procedure: Femoral nerve block
* Procedure: Intra-articular block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men and women, over the age of 18, electively assigned for primary knee replacement surgery. ASA score 1-3 Exclusion Criteria: Revision surgery Patients suffering from chronic pain syndrome or chronic opioid use. Patients with previous neurological deficits in the lower extremities. A cognitive state that does not allow signing of consent or understanding simple instructions.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Femoral nerve block<br>Patients undergoing total knee arthroplasty received a single-shot femoral nerve block during the surgical procedure. | Procedure: Femoral nerve block<br>* Patients who receive a femoral nerve block during surgery, fill out a questionnaire and undergo a muscle strength test before surgery, undergo functional tests, a muscle strength test and are asked about pain intensity after surgery.<br>|
| Experimental: Intra-articular block<br>Patients undergoing total knee arthroplasty received a intra-articular block during the surgical procedure. | Procedure: Intra-articular block<br>* Patients who receive an intra-articular block at the time of surgery, fill out a questionnaire and undergo a muscle strength test before surgery, undergo functional tests, a muscle strength test and are asked about pain intensity after surgery.<br>|
| No Intervention: Control group<br>Patients undergoing total knee arthroplasty and didn't receive pain block. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Timed up & go test | Total time to arise from chair, walk 3 m, turn around, return to chair and sit down. Two trials performed and the faster of the two is recorded to the nearest 10th of a second. | first and fifth day after the surgery | 
| Change in Elderly mobility scale | The EMS is a 20 point validated assessment tool for the assessment of frail elderly subjects. The EMS is measured on an ordinal scale of 0-20, when Scores under 10 - generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 - 13 - generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores over 14 - Generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL. | first and fifth day after the surgery | 
| Change in 5 times sit to stand test | The score is the amount of time (to the nearest decimal in seconds) it takes a patient to transfer from a seated to a standing position and back to sitting five times. | first and fifth day after the surgery | 
| Change in Numeric pain rating scale | An 11-point scale scored from 0 to 10: 0 = no pain, 10= the most intense pain imaginable | up to five days | 
| Chane in Quadriceps muscle strength | muscle strength measure by dynamometer (N⋅m) | A 1 day before the surgery, first and fifth day after the surgery. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospitalization duration | Number of days of hospitalization after the surgery- taken from the patient's file | At discharge (assessed up to day 10) | 
| Surgery duration | minutes- taken from the patient's file | During the surgery | 
| consumption of analgesics | taken from the patient's file | At discharge (assessed up to day 10) | 
| occurrence of falls | throughout the hospitalization- taken from the patient's file | At discharge (assessed up to day 10) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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post operative pain, total knee replacement, total knee arthroplasty, pain, post operative function, nerve block, intra-articular block