Clinical relevance of persistent postoperative pain after total hip replacement &amp;ndash; a prospective observational cohort study

Erlenwein, Joachim; Müller, Martin; Falla, Deborah; Przemeck, Michael; Pfingsten, M.; Budde, Stefan; Quintel, Michael; Petzke, Frank

doi:10.2147/jpr.s137892

Cited by 40 publications

(37 citation statements)

References 31 publications

(45 reference statements)

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“…However, in OA, long-lasting chronic pain pre-exists and is the main impetus for undergoing TJR, which complicates understanding post-surgical outcomes. Thus, it remains unclear the extent to which the post-surgical OA pain reflects residual presurgical pain, surgery induced pain, or some complex combination of both [6].…”

Section: Introductionmentioning

confidence: 99%

Prognostics for pain in osteoarthritis: Do clinical measures predict pain after total joint replacement?

et al. 2020

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A significant proportion of osteoarthritis (OA) patients continue to experience moderate to severe pain after total joint replacement (TJR). Preoperative factors related to pain persistence are mainly studied using individual predictor variables and distinct pain outcomes, thus leading to a lack of consensus regarding the influence of preoperative parameters on post-TJR pain. In this prospective observational study, we evaluated knee and hip OA patients before, 3 and 6 months post-TJR searching for clinical predictors of pain persistence. We assessed multiple measures of quality, mood, affect, health and quality of life, together with radiographic evaluation and performance-based tasks, modeling four distinct pain outcomes. Multivariate regression models and network analysis were applied to pain related biopsychosocial measures and their changes with surgery. A total of 106 patients completed the study. Pre-surgical pain levels were not related to post-surgical residual pain. Although distinct pain scales were associated with different aspects of post-surgical pain, multi-factorial models did not reliably predict post-surgical pain in knee OA (across four distinct pain scales) and did not generalize to hip OA. However, network analysis showed significant changes in biopsychosocial-defined OA personality post-surgery, in both groups. Our results show that although tested clinical and biopsychosocial variables reorganize after TJR in OA, their presurgical values are not predictive of post-surgery pain. Derivation of prognostic markers for pain persistence after TJR will require more comprehensive understanding of underlying mechanisms.

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Section: Introductionmentioning

confidence: 99%

Prognostics for pain in osteoarthritis: Do clinical measures predict pain after total joint replacement?

et al. 2020

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“…[ 1 – 3 ] However, some reports demonstrate that in more than 50% of the total hip replacement (THR) cases, postoperative pain management strategies adopted were not successful, and after total knee replacement (TKR), 75% of patients complained of moderate to severe chronic pain. [ 4 , 5 ] The critical role of postoperative pain within orthopedic surgery procedures is demonstrated by the fact that the effectiveness of a THR or TKR is often limited by the postoperative pain management itself. [ 6 ] In fact, intensive post-surgical rehabilitation, which has a fundamental role in recovering and maintaining the patient's complete movement abilities, can be hindered when a proper analgesia is not delivered to the patient, leading to worse patients’ satisfaction with their surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[ 9 – 10 ] If left untreated, acute pain can lead to long-term emotional and psychological distress that has the potential to develop into a chronic pain state which is even much more difficult to manage. [ 4 , 9 , 11 ]…”

Section: Introductionmentioning

confidence: 99%

Pain monitoring and management in a rehabilitation setting after total joint replacement

Luca

Ciccarello²,

Martorana

et al. 2018

Medicine

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Total hip replacement (THR) and, particularly, total knee replacement (TKR), are painful surgical procedures. Effective postoperative pain management leads to a better and earlier functional recovery and prevents chronic pain. Studies on the control of pain during the postoperative rehabilitation period are not common. The aim of this study is to present results of a perioperative anesthetic protocol, and a pain treatment protocol in use in the Orthopaedic and the Rehabilitation intensive units of our Hospital. 100 patients (50 THR and 50 TKR) were retrospectively included in this observational study. Numeric Rating Scale (NRS) for pain at rest registered in the clinical sheet was retrieved for all patients and analyzed with respect to the spinal anaesthesia given for the surgery, local analgesia, analgesia protocol adopted during the postoperative days in the Orthopaedic Unit, the antalgic treatment given during the stay within the Rehabilitation Unit, the postoperative consumption of rescue pain medication, and any collateral effect due to the analgesic therapy. Patients reached standard functional abilities (walking at least 50 meters and climbing/descending stairs) at a mean length of 8 days without medication-related complications. Mean NRS during the time of stay was 1.3 ± 0.3 for THR and 1.3 ± 0.2 for TKR) and maximum mean NRS was 1.8 ± 0.5 for TKR and 1.8 ± 0.6 for THR. The use of rescue therapy in the rehabilitation guard was correlated with the mean NRS pain and the maximum NRS pain. A very good control of pain with the perioperative anesthetic protocol and pain treatment protocol in use was obtained.

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“…It is recognized as an effective surgical intervention for alleviating pain and improving mobility and quality of life in these patients [8,9]. Yet, about one third suffer from persistent postoperative pain after THA and 3 to 16% report being dissatis ed with the outcome [10][11][12][13][14]. Several preoperative risk factors for dissatisfaction with surgical outcomes have been identi ed with high consistency across studies: higher age, female gender, comorbidities, associated conditions affecting walking capacity, mental distress, higher pain, and lower socioeconomic status [13,[15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

The Virtue of Optimistic Realism- Expectation Fulfillment Predicts Patient-Rated Global Effectiveness of Total Hip Arthroplasty

Kästner

Leong²,

Petzke³

et al. 2020

Preprint

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Abstract Background: Emerging evidence highlights the importance of preoperative expectations in predicting patient-reported outcomes of orthopedic surgeries. To date, it is still a matter of controversy whether patient satisfaction can be maximized by promoting either optimistic or realistic outcome expectations before surgery. Adjusting overly optimistic outcome expectancies in favor of a more realistic outlook on the limitations of total hip arthroplasty could reduce the risk of disappointment and lead to greater satisfaction with surgery outcomes. Our prospective cohort study was aimed at comparing the relative predictive influence of baseline expectations, expectation fulfillment and symptomatic improvement on the global effectiveness of total hip arthroplasty. Methods: Ninety patients (49 female, 41 male; mean age: 63±12.87 years) fulfilled inclusion criteria and completed a comprehensive preoperative assessment comprising sociodemographic, clinical, functional and psychological phenotypes. Moreover, the strengths of preoperative expectations for improvements in eight pain-related and functional domains were recorded on a 5-point Likert-scale. At 12 months after surgery, patients were asked to rate perceived improvements in each of these domains as well as the global effectiveness of the total hip replacement on a 5-point Likert-scale. To evaluate the relative impact of preoperative expectations, symptom improvement and the fulfillment of expectations on the global effectiveness of surgery, a hierarchical multiple linear regression analysis was performed. Results: Compared with the actual improvement at 12 months follow-up, prior expectations had been overly optimistic in about 28% of patients for hip pain, in about 45% for walking ability and around 60% for back pain, physical exercise, general function, social interactions and mental well-being. An optimistic hip pain expectation and the fulfillment of expectations for walking ability and independence in everyday life were found to independently predict global effectiveness ratings. Conclusions: In line with many authors investigating the relationship between the fulfillment of expectations and satisfaction with medical interventions, we suggest that professionals should explicitly address their patients’ expectations during the preoperative education and consultation. While for hip pain, high expectations seem to be beneficial, a realistic outlook encouraging self-efficacy expectancies should be conveyed for complex functional domains.

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Clinical relevance of persistent postoperative pain after total hip replacement – a prospective observational cohort study

Cited by 40 publications

References 31 publications

Prognostics for pain in osteoarthritis: Do clinical measures predict pain after total joint replacement?

Prognostics for pain in osteoarthritis: Do clinical measures predict pain after total joint replacement?

Pain monitoring and management in a rehabilitation setting after total joint replacement

The Virtue of Optimistic Realism- Expectation Fulfillment Predicts Patient-Rated Global Effectiveness of Total Hip Arthroplasty

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