Reducing Perioperative Oxidative Stress to Prevent Postoperative Chronic Pain Following Total Knee Arthroplasty

One of the most common surgical procedures performed in older adults is total knee arthroplasty (TKA), with an estimated 1 million TKAs performed annually in the United States. TKA directly addresses the pathology underlying knee joint pain and mobility limitations resulting from osteoarthritis. For most patients, TKA is effective for pain reduction and increasing function. However, a subgroup of 15-20% of TKA patients report unsatisfactory long-term pain outcomes well after postsurgical healing has occurred despite technical success of the procedure. Chronic postsurgical pain (CPSP) following TKA has been reported to be worse than the preoperative pain in 7% of TKA patients at up to 4-years. A potential biological mechanism is perioperative oxidative stress (OS),

The proposed project seeks to confirm the mechanistic role of OS in post-TKA CPSP and test the hypothesis that a perioperative intervention to reduce OS may reduce risk for CPSP post-TKA. This is a prospective randomized controlled trial that will assess preoperative, perioperative, and long-term oxidative stress (OS); pain; and functional outcomes over a 12 month period and test the hypothesis that a potent antioxidant intervention (GlyNAC) reduces OS and CPSP in patients undergoing total knee arthroplasty (TKA).

• Numeric Rating Scale (NRS) Rating of Worst Pain in the past 24 hours [Срок оценки: Baseline to 6 weeks and 12 months post TKA (13 months)]
• Numeric Rating Scale of Average Pain in the past 24 hours [Срок оценки: Baseline to 6 weeks, 6 months and 12 months post TKA (13 months)]
• Numeric Rating Scale of Least Pain in the past 24 hours [Срок оценки: Baseline to 6 weeks, 6 months and 12 months post TKA (13 months)]
• Mean change in McGill Pain Questionnaire-2 (MPQ-2) ratings of knee pain for average pain over past week of measurement. [Срок оценки: Baseline to 6 weeks, 6 months and 12 months post TKA (13 months)]
• Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) [Срок оценки: Baseline to 6 weeks, 6 months and 12 months post TKA (13 months)]
• PROMIS Short Form V1.0 - Pain Interference 8a scale [Срок оценки: Baseline to 6 weeks, 6 months and 12 months post TKA (13 months)]
• Postsurgical Opioid Use (pill count) [Срок оценки: Post-TKA discharge to 6 weeks, 6 months and 12 months post-TKA (12 months)]]
• Postsurgical Opioid Use (days of opioid use in the past week) [Срок оценки: 6 weeks, 6 months and 12 months post-TKA (12 months)]
• F2-Isoprostane/Isofuran (IsoP/IsoF) levels [Срок оценки: Baseline to 4 week pre-TKA assessment, and 6 weeks, 6 months and 12 months post TKA (13 months)]
• Glutathione levels [Срок оценки: Baseline to 4 week pre-TKA assessment, and 6 weeks, 6 months and 12 months post TKA (13 months)]