Total knee replacement: is it really an effective procedure for all?

摘要: Total knee replacement (TKR) is considered an effective intervention for the treatment of chronic pain and disability. Yet there increasing evidence, based on research using patient-based outcome measures, that a significant proportion patients experience pain, functional disability, poor quality life dissatisfaction after TKR. Although some outcomes TKR are due to surgical technique implant factors, much disability surgery medically unexplained. A range possible patient factors could contribute Socio-demographic have been found correlate with include female gender, older age low socio-economical status. Medical highly predictive greater number co-morbidities worse pre-operative psychological be including depression, self-efficacy, coping strategies, somatization, social support expectations. It also proposed biological explanation continuing involve central sensitisation, dysfunction modulation by nervous system. To improve selection TKR, future needs focus developing screening protocol identify those at risk unexplained