Chronic knee pain while awaiting arthroplasty is associated with worsening joint-specific function, health-related quality of life and personal wellbeing, and increased use of opioid analgesia

Listen to Simon and Amy discuss the paper 'Chronic knee pain while awaiting arthroplasty is associated with worsening joint-specific function, health-related quality of life and personal wellbeing, and increased use of opioid analgesia' published in the March 2025 issue of Bone & Joint Open.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint, brought to you by the publishers of Bone & Joint Open. Today we're delving into the paper, 'Chronic knee pain while awaiting arthroplasty is associated with worsening joint-specific function, health-related quality of life and personal wellbeing, and increased use of opioid analgesia', published in March 2025 by N D. Clement and colleagues. I'm Simon, and I'm joined by my co-host Amy. 

Hello everyone, delighted to be here. This study is quite thorough and highlights an important issue faced by many awaiting knee arthroplasty. Simon, let's begin with why this research is so important.

Knee osteoarthritis affects an estimated 654 million people globally and is the primary cause of knee pain in those over 45. Patients often endure severe pain while awaiting knee arthroplasty, which becomes necessary when conservative treatments fail. Extended wait times due to surgical backlogs have led to worsening health-related quality of life for these individuals. 

That's an [00:01:00] astonishing figure, Simon. The study sought to evaluate how chronic knee pain affects these patients during their wait. They concentrated on areas such as joint-specific function, overall health-related quality of life, personal wellbeing, and opioid use. Can you outline their methods for gathering data? 

They included 217 patients who had been on the waiting list for knee arthroplasty for at least six months. These patients completed various questionnaires including the EuroQol five-dimension questionnaire, Oxford Knee Score, and wellbeing assessments at six and 12 months after being listed. They also recorded analgesia use at 12 months. Chronic knee pain was identified using the Oxford Knee Score pain sub-score. 

What really stands out is that 77.9% of these patients were experiencing chronic knee pain at the 12-month mark. The results indicated these patients endured significantly worse knee-specific pain and function along with poorer health-related quality of life [00:02:00] compared to those without chronic knee pain. The odds ratio for having a health state worse than death was 29.7, which is quite significant.

Precisely Amy. Those suffering from chronic knee pain were more likely to use both weak and strong opioids for over three months while awaiting surgery. Their mental wellbeing also took a hit, shown by significantly lower scores in the categories of life satisfaction, feeling that life is worthwhile and happiness coupled with increased anxiety.

It paints a rather grim picture of how chronic pain can affect every aspect of someone's life. The study also discovered that the pain sub-score at six months was an effective predictor of chronic knee pain at 12 months. A score of less than 13 at six months was an excellent indicator for chronic knee pain with an area under the curve of 96.9.

Absolutely, this insight could be invaluable for clinicians. Identifying those at risk could help prioritize patients needing swifter intervention. The study also highlighted prolonged [00:03:00] opioid use, which despite having little effect on movement-related pain was seen in 40% of patients awaiting surgery. This underscores the desperation these patients face. 

Indeed, the implications are far reaching. Long-term opioid use raises the risk of dependency and poorer postoperative outcomes. Another disconcerting finding was the considerable economic burden. Each chronic knee pain patient incurs an additional £1,709 per year in healthcare costs. This along with more frequent GP visits points to a need for systemic changes. 

Precisely Amy. The study advocates reducing wait times for knee arthroplasty, not only to enhance patient outcomes, but also to lessen healthcare costs. It highlights a critical aspect of patient care that demands immediate attention. Before we conclude, what key points should our listeners take away? 

The first point to note is the high prevalence of chronic knee pain among those waiting for knee arthroplasty and its [00:04:00] severe impact on their quality of life. The second is the notable use of opioids despite their limited efficacy and associated risks. The final point is the importance of early identification of at-risk patients using tools like the Oxford Knee Score pain sub-score, which could perhaps prevent severe deterioration. Prioritizing surgery for these patients can make a significant difference. 

Well put, Amy. That's all we have time for today, do subscribe and join us next time for more discussions on the latest in orthopaedic research. 

Thank you everyone. Until next time.