PMID- 36556954 OWN - NLM STAT- MEDLINE DCOM- 20221226 LR - 20230308 IS - 1648-9144 (Electronic) IS - 1010-660X (Print) IS - 1010-660X (Linking) VI - 58 IP - 12 DP - 2022 Nov 29 TI - Central Sensitization Is Associated with Inferior Patient-Reported Outcomes and Increased Osteotomy Site Pain in Patients Undergoing Medial Opening-Wedge High Tibial Osteotomy. LID - 10.3390/medicina58121752 [doi] LID - 1752 AB - Background and Objectives: Studies have shown that centrally sensitized patients have worse clinical outcomes following total knee arthroplasty (TKA) than non-centrally sensitized patients. It is unclear whether central sensitization (CS) affects patient-reported outcomes (PROs) and/or level of osteotomy site pain in patients undergoing medial opening-wedge high tibial osteotomy (MOWHTO). The purpose of this study was to determine whether CS is associated with PROs and osteotomy site pain following MOWHTO. Materials and Methods: A retrospective evaluation was conducted on 140 patients with varus knee osteoarthritis (OA) who were treated with MOWHTO and monitored for two years. Before surgery, the Central Sensitization Inventory (CSI) was used to assess CS status, and a CSI of 40 or higher was considered indicative of CS. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and pain visual analogue scale (VAS) were used to assess PROs. The minimal clinically important difference (MCID) for the WOMAC was set as 4.2 for the pain subscore, 1.9 for the stiffness subscore, 10.1 for the function subscore, and 16.1 for the total based on the results of a previous study. The WOMAC score, pain VAS score of the osteotomy site, and the achievement rates of WOMAC MCID were compared between the CS and non-CS groups. Results: Thirty-seven patients were assigned to the CS group, whereas 84 were assigned to the non-CS group. Before surgery, the CS group showed a higher WOMAC score than the non-CS group (58.7 vs. 49.4, p < 0.05). While there was a statistically significant improvement in WOMAC subscores (pain, stiffness, function, and total) for both groups at two years after surgery (all p < 0.05), the CS group had a higher WOMAC score than the non-CS group (37.1 vs. 21.8, p < 0.05). The CS group showed significantly inferior results in pre- and postoperative changes of WOMAC subscores (pain, function, and total) relative to the non-CS group (all p < 0.05). In addition, pain at the osteotomy site was more severe in the CS group than in the non-CS group at two years after surgery (4.8 vs. 2.2, p < 0.05). Patients with CS had worse MCID achievement rates across the board for WOMAC pain, function, and total scores (all p < 0.05) compared to the non-CS group. Conclusions: Centrally sensitized patients following MOWHTO had worse PROs and more severe osteotomy site pain compared to non-centrally sensitized patients. Furthermore, the WOMAC MCID achievement rate of patients with CS was lower than that of patients without CS. Therefore, appropriate preoperative counseling and perioperative pain management are necessary for patients with CS undergoing MOWHTO. Level of Evidence: Level III, case-control study. FAU - Kim, Jae-Jung AU - Kim JJ AD - Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea. FAU - Koh, In-Jun AU - Koh IJ AD - Department of Orthopaedic Surgery, EunPyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea. FAU - Kim, Man-Soo AU - Kim MS AUID- ORCID: 0000-0002-1374-9964 AD - Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea. FAU - Choi, Keun-Young AU - Choi KY AD - Department of Orthopaedic Surgery, EunPyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea. FAU - Kang, Ki-Ho AU - Kang KH AUID- ORCID: 0000-0002-4815-7985 AD - Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea. FAU - In, Yong AU - In Y AUID- ORCID: 0000-0002-5932-3934 AD - Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea. LA - eng PT - Journal Article DEP - 20221129 PL - Switzerland TA - Medicina (Kaunas) JT - Medicina (Kaunas, Lithuania) JID - 9425208 SB - IM MH - Humans MH - *Knee Joint/surgery MH - *Osteoarthritis, Knee/complications/surgery MH - Retrospective Studies MH - Case-Control Studies MH - Central Nervous System Sensitization MH - Tibia/surgery MH - Pain/etiology MH - Osteotomy/adverse effects/methods MH - Patient Reported Outcome Measures MH - Treatment Outcome PMC - PMC9783071 OTO - NOTNLM OT - central sensitization OT - medial opening-wedge high tibial osteotomy OT - minimal clinically important difference OT - osteotomy site pain OT - patient-reported outcomes COIS- The authors declare no conflict of interest. EDAT- 2022/12/24 06:00 MHDA- 2022/12/27 06:00 PMCR- 2022/11/29 CRDT- 2022/12/23 01:43 PHST- 2022/09/14 00:00 [received] PHST- 2022/11/22 00:00 [revised] PHST- 2022/11/29 00:00 [accepted] PHST- 2022/12/23 01:43 [entrez] PHST- 2022/12/24 06:00 [pubmed] PHST- 2022/12/27 06:00 [medline] PHST- 2022/11/29 00:00 [pmc-release] AID - medicina58121752 [pii] AID - medicina-58-01752 [pii] AID - 10.3390/medicina58121752 [doi] PST - epublish SO - Medicina (Kaunas). 2022 Nov 29;58(12):1752. doi: 10.3390/medicina58121752.