Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact

Patrícia R Pinto,^1–3 Teresa McIntyre,^4,5 Ramón Ferrero,⁶ Vera Araújo-Soares,^3,7 Armando Almeida<sup>1,2

1</sup>Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal; ²Life and Health Sciences Research Institute/3Bs, PT Government Associate, Braga/Guimarães, Portugal; ³Health Psychology Group, Newcastle University, Newcastle, UK; ⁴Texas Institute for Measurement, Evaluation and Statistics, ⁵Department of Psychology, University of Houston, TX, USA; ⁶Alto Ave Hospital Center, Orthopedics Unit, Guimarães, Portugal; ⁷Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle, UK

Abstract: This study compares the incidence, nature, and impact of persistent post-surgical pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and investigates differences between these procedures, with the focus on potential presurgical and post-surgical issues that could be related to the distinct persistent post-surgical pain outcomes between these two groups. A consecutive sample of 92 patients was assessed prospectively 24 hours before, 48 hours, and 4–6 months after surgery. The data show that TKA patients had a higher likelihood of developing persistent post-surgical pain, of reporting higher pain levels, and of using more neuropathic descriptors when classifying their pain. In addition, TKA patients more often reported interference from pain on functional domains, including general activity, walking ability, and normal work. Demographic factors, like gender and age, along with presurgical clinical factors like disease onset, existence of medical comorbidities, and other pain problems, may have contributed to these differences, whereas baseline psychologic factors and functionality levels did not seem to exert an influence. Heightened acute post-surgical pain experience among TKA patients could also be related to distinct outcomes for persistent post-surgical pain. Future prospective studies should therefore collect TKA and THA samples wherein patients are homogeneous for demographic and presurgical clinical issues. Overall, these findings contribute to a small but growing body of literature documenting persistent post-surgical pain after major arthroplasty, conducted in different countries and across different health care settings.

Keywords: total knee arthroplasty, total hip arthroplasty, persistent post-surgical pain, demographic factors, clinical factors, psychologic factors