Long-term pain after knee surgery reduced, new treatment has shown


Date:
January 29, 2022
Source:
University of Bristol
Summary:
With one in five people experiencing ongoing pain long after knee
replacement surgery, new research has shown a way to help reduce
people's continuing pain that could also save time and money too.



FULL STORY ==========================================================================
With one in five people experiencing ongoing pain long after
knee replacement surgery, new research, led by the University of
Bristol and North Bristol NHS Trust (NBT) and published in The Lancet Rheumatologytoday [27 January], has shown a way to help reduce people's continuing pain that could also save the NHS time and money too.


==========================================================================
One hundred thousand knee replacement surgeries are carried out in the
UK every year. Most of these operations take place to treat pain related
to osteoarthritis. Unfortunately, each year, around 20,000 people who
have knee replacement surgery to relieve their pain find that they have moderate to severe pain three months or longer after their operation,
which impacts on their everyday lives.

The study found the STAR care pathway (Support and Treatment After
joint Replacement) reduces pain severity, the amount pain interferes
with people's lives and is cost-effective. The new treatment could
potentially save the NHS up to -L-14 million per year through reduced
inpatient admissions.

The study found patients who received the STAR care pathway had:
* Less pain severity and impact on daily life at both six and
12 months
after treatment (nine and 15 months after surgery)
* Half the number of hospital re-admissions * Reduced length of
hospital stay for any inpatient admissions three months
after surgery
* Less unpaid time off work
The aim of the five-year STAR programme was to find ways to improve the
care and support that people with ongoing pain receive. The programme,
funded by the National Institute for Health Research (NIHR), designed
and tested a new treatment in a randomised controlled trial in eight
UK hospitals.

The programme looked at how likely patients are to get ongoing knee pain
after their operation and discovered why patients don't seek help. The
research team developed a new treatment -- a care pathway -- for patients
and compared how patients did on the STAR care pathway when compared
with a control group who had the usual care.



==========================================================================
STAR care pathway:
* Three months after surgery patients attended an hour-long clinic,
ran by
specially trained health care professionals
* Detailed pain questionnaires were filled out and X-rays were
taken as
well as a blood test for infection. If needed patients were referred
for further ongoing treatment
* Patients received up to six 'phone calls over the next 12 months,
making
sure they had their referral, and to check how they were doing
Rachael Gooberman-Hill, lead researcher for the STAR programme, Professor
of Health and Anthropology and Director of Bristol's Elizabeth Blackwell Institute, said: "People have a knee replacement to relieve their pain
and it's immensely disappointing if they find that they have long-term
pain afterwards.

Unfortunately, one in five people who have knee replacement have long-term
pain afterwards -- that is around 20,000 people each year in the UK alone.

"As a research team we wanted to do something that would help. We
found that our new STAR care pathway had a positive impact on people's
pain. People who had long-term pain after their knee replacement and
who were given STAR had less pain and the pain interfered less with
their lives one year later. People told us that STAR helped them to
feel supported, to find out more about their pain and STAR meant that
they were able to get further treatment that was tailored to their
pain. We are enormously pleased with our research findings because it
should make a real difference to people who find that they have pain
after their knee replacement." Brenig, a participant on the STAR trial, explained: "As part of the STAR trial, you have tailored physiotherapy appointments. At my three-month review with a STAR physiotherapist,
I was having a problem not being able to straighten my leg out. She
gave me some simple exercises, which worked and straightened the leg
out. Occasionally I have problems at the back of the knee, then I do
the exercises and it goes back to normal. So that was a very positive
side of what we actually did.

"I felt that being part of the STAR trial gave me access to a specialist physiotherapist. Her knowledge was far, far superior and specific to
my issue.

Some mornings I get up and feel on top of the world and then the
following day I have leg pain. Eventually you get to accept it, but
doing the exercises helps." The study has benefited greatly from
Bristol's Musculoskeletal Research Unit's patient involvement group,
PEP-R (Patient Experience Partnership in Research) who worked closely
with the STAR research team to develop the design of the programme.

Dr Vikki Wylde, Associate Professor in Musculoskeletal Health at
Bristol Medical School (THS), and co-author, added: "The new STAR care
pathway provides benefit to people with pain at three months after
knee replacement, but we still need more research to understand how we
could prevent people from developing this pain. High-quality research to pre-operatively identify patients at high risk of developing pain after
their operation is needed. These patients could be offered treatments
to increase their chance of a good outcome after knee replacement."
Nick Howells, Consultant Orthopaedic Knee Surgeon at NBT and Honorary
Senior Lecturer at Bristol Medical School: THS, continued: "Knee
replacement surgery is a great operation that changes the lives of many
people suffering with knee osteoarthritis, improving pain, function and
quality of life, however, a proportion of people are left with ongoing
pain. To have developed an intervention which has been shown to make a difference for some of these people is really satisfying for our team
and a great step forward in treatment.

"We have now successfully introduced the STAR care pathway
into our NHS clinical care pathway at North Bristol and hope
it will be adopted in other centres across the NHS in the future." ========================================================================== Story Source: Materials provided by University_of_Bristol. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Vikki Wylde, Wendy Bertram, Emily Sanderson, Sian Noble, Nicholas
Howells, Tim J Peters, Andrew D Beswick, Ashley W Blom, Andrew
J Moore, Julie Bruce, David A Walsh, Christopher Eccleston,
Shaun Harris, Kirsty Garfield, Simon White, Andrew Toms, Rachael
Gooberman-Hill, Amanda Burston, Jane Dennis, Paul Dieppe, Benjamin
Burston, Vikram Desai, Tim Board, Colin Esler, Michael Parry,
Jonathan R.A. Phillips. The STAR care pathway for patients with
pain at 3 months after total knee replacement: a multicentre,
pragmatic, randomised, controlled trial. The Lancet Rheumatology,
2022; DOI: 10.1016/S2665-9913(21)00371-4 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/01/220129084222.htm

--- up 8 weeks, 7 hours, 13 minutes
* Origin: -=> Castle Rock BBS <=- Now Husky HPT Powered! (1:317/3)