Acute pain after total hip and knee arthroplasty does not affect chronic pain during the first postoperative year: observational cohort study of 389 patients

P. J. Damen,C. H. Martini,W. C. M. Marijnissen,R. Onstenk,S. B. W. Vehmeijer,The Longitudinal Leiden Orthopaedics Outcomes Of Osteoarthritis Study (Loas) Group ,S. H. M. Verdegaal,R. G. H. H. Nelissen,D. A. J. M. Latijnhouwers,T. P. M. Vliet Vlieland,M. G. J. Gademan,H. M. J. van der Linden,H. H. Kaptijn,B. L. Kaptein

doi:10.1007/s00296-022-05094-4

Abstract

Chronic pain is frequently reported after total hip and knee arthroplasties (THA/TKA) in osteoarthritis (OA) patients. We investigated if severity of acute postoperative pain following THA/TKA in OA patients was associated with pain during the first postoperative year. From an observational study, OA patients scheduled for primary THA/TKA (June 2012–December 2017) were included from two hospitals in the Netherlands. Acute postoperative pain scores were collected within 72 h postoperatively and categorized as no/mild (NRS ≤ 4) or moderate/severe (NRS > 4). Pain was assessed preoperatively, 3, 6 and 12 months postoperatively using the HOOS/KOOS subscale pain. With Multilevel Mixed-effects-analyses, we estimated associations between acute and chronic pain until one year postoperative, adjusted for confounders and including an interaction term (Time*Acute pain). 193 THA and 196 TKA patients were included, 29% of THA and 51% of TKA patients reported moderate/severe pain acutely after surgery. In the THA group, the difference in pain at 3 months between the no/mild and moderate/severe groups, was approximately six points, in favor of the no/mild group (95% CI [−12.4 to 0.9]) this difference became smaller over time. In the TKA group we found similar differences, with approximately four points (95% CI [−9.6 to 1.3]) difference between the no/mild and moderate/severe group at 6 months, this difference attenuated at 12 months. No association between severity of acute postoperative pain and pain during the first postoperative year was found. These findings suggest that measures to limit acute postoperative pain will likely not impact development of chronic pain.

Highlights

20% of the general adult population suffers from OA of the knee, hip or hand, with increasing numbers due to age and obesity, resulting in increasing numbers of patients in pain due to OA [1]
In this study we investigated if severity of acute postoperative pain, following THA or TKA in OA patients, was associated with pain during the first postoperative year
Our findings indicated that severity of acute postoperative pain after THA or TKA was not associated with postoperative pain during the first postoperative year in this population

Summary

Introduction

20% of the general adult population suffers from OA of the knee, hip or hand, with increasing numbers due to age and obesity, resulting in increasing numbers of patients in pain due to OA [1]. A previous study including patients with knee OA, showed that 41% of patients experience mild pain, 40% experienced moderate pain and 20% experienced severe pain [3]. Apart from the fact that patients often suffer from pain prior to surgery, chronic pain after total hip and knee arthroplasty (THA/TKA) is an often reported unfavorable outcome [6, 7], with chronic pain defined as recurring or being present for more than 3 months [8]. The presence of chronic postoperative pain after arthroplasty surgery could have substantial unfavorable effects, including delayed postoperative rehabilitation [9], a negative impact on quality of life [10], decreased postoperative satisfaction [11] and increased the risk of revision surgery and additional healthcare costs [12, 13]. New treatments targeting the prevention of the development of chronic postoperative pain after total joint arthroplasties are of utmost importance

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