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Joint replacement patients with fibromyalgia show high levels of dissatisfaction postoperatively

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LAS VEGAS — When considering a patient with fibromyalgia for total joint replacement, surgeons should be aware that, in a small study, these patients showed high levels of dissatisfaction postoperatively. “These are patients who basically have a very low threshold for pain. They’re hypersensitized and they hurt at all times,” Javad Parvizi, MD, FRCS, said during the American Academy of Orthopaedic Surgeons 76th Annual Meeting, here. “Unfortunately, these patients are not great candidates for joint arthroplasty based on this study.”

Fibromyalgia, he explained, is diagnosed as pain at rest associated with central sensitization. In general, patients with a high preoperative pain have less favorable outcomes in terms of pain relief..

He showed data from his small prospective study looking at 64 fibromyalgia patients who underwent total knee arthroplasty at the Rothman Institute in Philadelphia between 2000 and 2007. These patients were matched in a two-to-oneratio and underwent SF-36 and Likert Scale testing with a maximum of 400 points.

“The finding was that fibromyalgia patients were, first, less satisfied with the surgery as measured by Likert’s scale and, unfortunately, they had lower mental and physical SF-36 scores. The dissatisfaction [rate] was much higher among fibromayalgia patients than others,” Parvizi said.

He also showed that 35% of fibromyalgia patients were dissatisfied with their procedures, as compared to 9% of their matched controls.

“This suggests that patients with fibromyalgia are great candidates for preoperative therapy and counseling,” Parvizi said. ”It’s better if you have a patient with fibromyalgia who’s under control and can be treated first before you deal with their degenerative joint diseases.”

Reference:

• Parvizi J. Choosing the right patient. Part of a symposium on Early Failures after total knee arthroplasty: Strategies for prevention. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.