On December 13, 2016 The Journal of Bone and Joint Surgery (JBJS) and Pain hosted a webinar entitled, “Managing Knee-Arthritis Pain Before and After Surgery.” Nitan B. Jain, M.D., M.S.P.H., JBJS Associate Editor, moderated the program. Dr. Jain, co-director of Sports Medicine Research and Director of Shoulder Research at Vanderbilt University, moderated the event. He told OTW, “This program evolved as the result of a joint invitation from JBJS and Pain; both journals are aware of the importance and prevalence of knee osteoarthritis (OA).”
JBJS, Pain Webinar on Knee Arthritis
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“The event, which drew signups of approximately 1, 000 participants, looked at an important topic: the role of central sensitization in pain generation in knee OA. Dr. Jain noted, “The mechanism by which central sensitization occurs is not fully understood. We surmise, however, that there is arthritis in the knee that is locally causing knee pain, but that once the stimulus remains for a while then the central nervous system gets involved and pain is amplified.”
“In formulating the agenda we worked from two research articles. One appeared in Pain and examined findings from a randomized controlled trial (RCT) COX-2 inhibitor etoricoxib (in the family of COX-2 inhibitors). This study showed that it is not just peripheral nociceptive pain that etoricoxib is targeting, but it is the central sensitization phenomenon that helps offer pain relief in patients with knee OA. We don’t always consider etoricoxib or think about central sensitization preoperatively, but we should try this before surgery.”
“The other article, a Level 1 RCT, appeared in JBJS. This work compared intraoperative periarticular injections to postop epidural analgesia as far as pain management immediately postop after total knee replacement (72 hours). This work found that periarticular injection was associated with improved pain control in patients undergoing bilateral knee replacement.”
“We had a very engaging audience who had a lot of questions on the complications of periarticular injections and the composition of the medication cocktail. Those orthopedic surgeons and clinicians who missed the event will be able to access it online until one year after the event.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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