Transition from Acute to Chronic Pain in Total Knee Arthroplasty Patients: Identifying Resilience and Vulnerability Profiles

项目摘要/摘要 骨关节炎(OA)是导致中老年残疾的最重要原因。约2700万 在美国，有1000万人患有这种无法治愈的膝骨性关节炎。全膝 关节成形术(TKA)是非手术治疗失败的膝关节骨性关节炎致残患者的可靠治疗选择 治疗，其中58%是在65岁或以上的患者身上进行的。TKA手术是 2012年在美国对70多万名患者进行了手术，估计这一数字将 到2050年增长143%到565%。大多数患者在6至12周内疼痛缓解。 TKA后：然而，8%至34%的患者经历了国际定义的慢性术后疼痛 疼痛作为手术后持续3个月以上的临床重要疼痛研究协会 尽管手术过程顺利且令人满意，但功能结果改善有限 放射照片的外观。据预测，到2019年，美国每年将有348万例TKA手术 2030年，每年有多达50万名患者可能会在TKA后出现慢性疼痛。这个项目的目标是 以帮助构建涵盖临床、生物学(组学)、心理学、 接受全膝关节置换术的不同患者组的社会经济学和影像预测因素。拉什大学 伊利诺伊州最大的关节置换手术提供商，2017年进行了2100例TKA手术。带着我们的 转化医学研究所(ITM)合作伙伴、芝加哥大学和北岸大学健康 我们的NCATS CTSA资助的项目中心拥有广泛的翻译研究专业知识，并为 多样化的患者群体(500万英镑)，跨越许多种族、民族和社会经济阶层，并集体 每年进行超过4000例TKA手术。拟议研究性研究的总体项目目标是 与临床协作一起提供高保真的临床、生物和心理数据 来自患者的OMICS数据生成中心、数据集成和资源中心 在我们的NCATS CTSA资助的项目中心内进行TKA，符合NIH Hear Initiative A2CPS。这 信息应该丰富我们对手术后急性疼痛如何转变为慢性疼痛的理解 提高我们针对患者的有效预防和治疗策略的能力。

Project Summary/Abstract Osteoarthritis (OA) is the single most important cause of disability in mid and late life. About 27 million people in the United States suffer from this incurable process and 10 million have OA of the knee. Total knee arthroplasty (TKA) is a reliable treatment option for patients disabled by knee OA who have failed nonoperative treatment, with 58% of these surgeries being performed on patients 65 years or older. TKA surgeries were performed on more than 700,000 patients in the United States in 2012 and estimates expect this number to increase between 143% and 565% by 2050. Most patients experience pain relief within 6 to 12 weeks following TKA; however, 8 to 34% of patients experience chronic postsurgical pain, defined by the International Association for the Study of Pain as clinically important pain lasting more than 3 months after surgery, with limited improvement in functional outcomes often despite an uneventful surgical course and a satisfactory radiographic appearance. With one projected estimate of 3.48 million TKA surgeries per year in the USA by 2030, up to 500,000 patients annually could develop chronic pain following TKA. The objective of this project is to aid in the construction of a dataset that encompasses clinical, biological (omics), psychological, socioeconomical and imaging predictors for a diverse group of patients undergoing TKA. Rush University the largest provider of joint replacement surgery in Illinois, performing 2,100 TKA procedures in 2017. With our Institute for Translational Medicine (ITM) partners, the University of Chicago, and NorthShore University Health System our NCATS CTSA-funded program hub has extensive translational research expertise and serves a diverse patient population (>5 million) across many racial, ethnic and socioeconomic strata and collectively perform more than 4000 TKA procedures per year. The overall project goal of the proposed research study is to provide high fidelity clinical, biological and psychological data in conjunction with Clinical Coordination Center, the Data Integration and Resource Center, and the Omics Data Generation Center from patients undergoing TKA within our NCATS CTSA-funded program hub in line with NIH HEAL Initiative A2CPS. This information should enrich our understanding of how acute pain becomes chronic pain following surgery and enhance our ability to target effective preventive and treatment strategies for patients.