A systematic review of preoperative determinants of patient-reported pain and physical function up to 2 years following primary unilateral total hip arthroplasty

Lungu, Eugen; Maftoon, S.; Vendittoli, Pascal‐André; Desmeules, François

doi:10.1016/j.otsr.2015.12.025

Cited by 31 publications

(51 citation statements)

References 29 publications

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“…The first was in relation to baseline function/disability with the majority of studies showing that worse baseline function predicted poor outcome, this was however not the case when studies looked at change scores rather than purely follow‐up outcome, for example Hofstede et al () found that a lower functional PROM score (indicating lower function) predicted worse outcome conforming to other studies but also to greater improvement (change). This was also found by Harmelink et al (), and Lungu, Maftoon, Vendittoli, and Desmeules (), Lungu, Vendittoli, and Desmeules (). This shows that patients with lower functional scores achieve a better outcome with regard to health gain but still a worse overall outcome than those with higher baseline scores in relation to follow‐up functional PROM scores achieved.…”

Section: Discussionsupporting

confidence: 81%

Predictors of functional outcome in musculoskeletal healthcare: An umbrella review

Burgess

Mansell

Bishop

et al. 2019

European Journal of Pain

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Background Multiple cohort and systematic review studies exist, reporting independent predictive factors associated with outcome in musculoskeletal populations. These studies have found evidence for a number of “generic” factors that have been shown to predict outcome across musculoskeletal patient cohorts. This review provides a higher level review of the evidence with a focus on generic patient factors associated with functional musculoskeletal outcome with a view to informing predictive modelling. Objectives (a) Identify patient factors found to have evidence to support their association with functional outcome, and (b) review these findings across body areas/conditions to identify generic predictive factors. Databases and Data Treatment Electronic databases of MEDLINE, AMED, EMBASE, CINAHL and Cochrane were searched for eligible studies. Two reviewers independently extracted data and assessed quality using an established checklist for umbrella reviews. Results Twenty‐one systematic reviews met inclusion criteria, all were of moderate/high quality. Six independent predictors were found to have strong evidence of association with worse musculoskeletal functional outcome across anatomical body sites (worse baseline function, higher symptom/pain severity, worse mental well‐being, more comorbidities, older age and higher body mass index). Longer duration of symptoms, worse pain coping, presence of workers compensation, lower vitality and lower education were also found to have moderate evidence of association with worse functional outcome across body sites. Conclusions This study identifies a number of factors associated with musculoskeletal functional outcome. The generic predictive factors identified should be considered for inclusion into musculoskeletal prognostic models, including models used for case‐mix‐adjustment of patient reported outcome measure data. Significance This article identifies “generic” patient factors that predict functional outcome (measured using Patient Reported Outcome Measures (PROMs)) across musculoskeletal conditions. Findings provide support for the development and content of generic musculoskeletal prognostic models including models used to case‐mix adjust PROM data for baseline complexity. Generic musculoskeletal models and functional PROMs would facilitate more feasible comparison and benchmarking of musculoskeletal services in order to identify variation and address health inequalities.

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Section: Discussionsupporting

confidence: 81%

Predictors of functional outcome in musculoskeletal healthcare: An umbrella review

Burgess

Mansell

Bishop

et al. 2019

European Journal of Pain

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“…However, Lungu et al. (2016) did not find any significant association between age and outcomes after THA. In our hospital, there is selection of patients who are to be operated in an outpatient setting, and they must fulfill the following criteria: ASA I or II; being motivated to go home on the day of surgery; having no cardiovascular history; not having insulin-dependent diabetes; and having sufficient support from a caring person at home during the first night postoperatively (Hartog et al.…”

Section: Discussionmentioning

confidence: 85%

“…Lungu et al. (2016) found that a greater level of comorbidity and worse general health are associated with worse pain and function following THA.…”

Section: Discussionmentioning

confidence: 99%

The first 6 weeks of recovery after primary total hip arthroplasty with fast track

et al. 2017

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Background and purposeFast-track protocols have been introduced worldwide to improve the recovery after total hip arthroplasty (THA). These protocols have reduced the length of hospital stay (LOS), and THA in an outpatient setting is also feasible. However, less is known regarding the first weeks after THA with fast track. We examined patients’ experiences of the first 6 weeks after hospital discharge following inpatient and outpatient THA with fast track.Patients and methodsIn a prospective cohort study, 100 consecutive patients who underwent THA surgery in a fast-track setting between February 2015 and October 2015 received a diary for 6 weeks. This diary contained various internationally validated questionnaires including HOOS-PS, OHS, EQ-5D, SF-12, and ICOAP. In addition, there were general questions regarding pain, the wound, physiotherapy, and thrombosis prophylaxis injections.Results94 patients completed the diary, 42 of whom were operated in an outpatient setting. Pain and use of pain medication had gradually decreased during the 6 weeks. Function and quality of life gradually improved. After 6 weeks, 91% of all patients reported better functioning and less pain than preoperatively.InterpretationFast track improves early functional outcome, and the PROMs reported during the first 6 weeks in this study showed continued improvement. They can be used as a baseline for future studies. The PROMs reported could also serve as a guide for staff and patients alike to modify expectations and therefore possibly improve patient satisfaction.

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“…Although hip and knee replacement are performed to reduce pain and regain function in patients with late-stage arthritis [1,2], 10-20% of patients continue to suffer from persistent pain after surgery [3,4]. The latest studies focusing on persistent pain indicate that its major risk factors include pain catastrophizing, intensity of preoperative pain, mental health problems, knee surgery, and certain comorbidities, such as diabetes [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

et al. 2020

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Background: Pain persists in a moderate number of patients following hip or knee replacement surgery. Persistent pain may subsequently lead to the prolonged consumption of analgesics after surgery and expose patients to the adverse drug events of opioids and NSAIDs, especially in older patients and patients with comorbidities. This study aimed to identify risk factors for the increased use of opioids and other analgesics 1 year after surgery and focused on comorbidities and surgery-related factors. Methods: All patients who underwent a primary hip or knee replacement for osteoarthritis from 2002 to 2013 were identified. Redeemed prescriptions for acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids (mild and strong) were collected from a nationwide Drug Prescription Register. The user rates of analgesics and the adjusted risks ratios for analgesic use 1 year after joint replacement were calculated.Results: Of the 6238 hip replacement and 7501 knee replacement recipients, 3591 (26.1%) were still using analgesics 1 year after surgery. Significant predictors of overall analgesic use (acetaminophen, NSAID, or opioid) were (risk ratio (95% CI)) age 65-74.9 years (reference < 65), 1.1 (1.03-1.2); age > 75 years, 1.2 (1.1-1.3); female gender, 1.2 (1.1-1.3); BMI 30-34.9 kg/m 2 (reference < 25 kg/m 2 ), 1.1 (1.04-1.2); BMI > 35 kg/m 2 , 1.4 (1.3-1.6); and a higher number of comorbidities (according to the modified Charlson Comorbidity Index score), 1. 2 (1.1-1.4). Diabetes and other comorbidities were not significant independent predictors. Of the other clinical factors, the preoperative use of analgesics, 2.6 (2.5-2.8), and knee surgery, 1.2 (1.1-1.3), predicted the use of analgesics, whereas simultaneous bilateral knee replacement (compared to unilateral procedure) was a protective factor, 0.86 (0.77-0.96). Opioid use was associated with obesity, higher CCI score, epilepsy, knee vs hip surgery, unilateral vs bilateral knee operation, total vs unicompartmental knee replacement, and the preoperative use of analgesics/opioids. Conclusions: Obesity (especially BMI > 35 kg/m 2 ) and the preoperative use of analgesics were the strongest predictors of an increased postoperative use of analgesics. It is remarkable that also older age and higher number of comorbidities predicted analgesic use despite these patients being the most vulnerable to adverse drug events.

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A systematic review of preoperative determinants of patient-reported pain and physical function up to 2 years following primary unilateral total hip arthroplasty

Abstract: Level II. Systematic review of cohort studies.

Cited by 31 publications

References 29 publications

Predictors of functional outcome in musculoskeletal healthcare: An umbrella review

Predictors of functional outcome in musculoskeletal healthcare: An umbrella review

The first 6 weeks of recovery after primary total hip arthroplasty with fast track

Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

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