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  • A Cross-Sectional Survey on Prevalence and Risk Factors for Persistent Postsurgical Pain 1 Year After Total Hip and Knee Replacement

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ORIGINAL ARTICLES
A Cross-Sectional Survey on Prevalence and Risk Factors for Persistent Postsurgical Pain 1 Year After Total Hip and Knee Replacement
  1. Spencer S. Liu, MD*,
  2. Asokumar Buvanendran, MD†,
  3. James P. Rathmell, MD‡,
  4. Mona Sawhney, NP, MN§,
  5. James J. Bae, MSc*,
  6. Mario Moric, MS†,
  7. Stephen Perros, BS‡,
  8. Ashley J. Pope, HBSc§,
  9. Lazaros Poultsides, MD, PhD∥,
  10. Craig J. Della Valle, MD,
  11. Naomi S. Shin, BA‡,
  12. Colin J.L. McCartney, MB ChB, FRCA FRCPC§,
  13. Yan Ma, PhD#,
  14. Mahendrakumar Shah, MD†,
  15. Monica J. Wood, BS‡,
  16. Smith C. Manion, MD‡ and
  17. Thomas P. Sculco, MD∥
  1. From the *Department of Anesthesiology, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY;
  2. †Department of Anesthesiology, Rush University Medical Center and Rush Medical College, Chicago, IL;
  3. ‡Department of Anesthesia, Critical Care and Pain Medicine and Harvard Medical School, Boston, MA;
  4. §Department of Anesthesia, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada;
  5. ∥Department of Orthopedic Surgery, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY;
  6. Department of Orthopedic Surgery, Rush University Medical Center and Rush Medical College, Chicago, IL; and
  7. #Department of Public Health, Weill Cornell Medical College, New York, NY.
  1. Address correspondence to: Spencer S. Liu, MD, Department of Anesthesiology, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (e-mail: liusp{at}hss.edu).

Abstract

Background and Objectives There is a paucity of large multi-institutional surveys to determine the prevalence of and risk factors for persistent pain after total hip (THR) and knee (TKR) replacements. We surveyed a variety of practices and patients and also correlated persistent pain with health-related quality-of-life outcomes.

Methods From October 10, 2007, to March 15, 2010, patients who had undergone primary THR or TKR with a minimum follow-up of 1 year were identified. A previously published questionnaire to identify persistent postsurgical pain that included a 36-item Short Form Health Survey was mailed to this group. Independent risk factors for persistent pain were identified with logistic regression.

Results Responses from 1030 patients who underwent surgery at some point in time between June 13, 2006, and June 24, 2009, were analyzed (32% response rate). Forty-six percent of patients reported persistent pain (38% after THR and 53% after TKR) with a median average pain score of 3 of 10 and worst pain score of 5. Independent risk factors for persistent pain were female sex (odds ratio [OR], 1.23), younger age (OR, 0.97), prior surgery on hip or knee (OR, 1.39), knee versus hip replacement (OR, 1.65), lower-quality postsurgical pain control (OR, 0.9), and presence of pain in other areas of the body (OR, 2.09). All scores in the 36-item Short Form Health Survey were worse (8%–28% decrease) in patients with persistent postsurgical pain (P < 0.001).

Conclusions Persistent postsurgical pain is common after THR and TKR and is associated with reduced health-related quality of life, although our survey may be biased by the low response rate and retrospective recall bias. Nonmodifiable risk factors may lead to risk stratification. Severity of acute postoperative pain may be a modifiable risk factor.

https://doi.org/10.1097/AAP.0b013e318251b688

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    Footnotes

    • Funding was provided by the Department of Anesthesiology, Hospital for Special Surgery. Dr. Ma was partially supported by Clinical Translational Science Center (National Institutes of Health UL1-RR024996). Dr. Della Valle is a consultant for Biomet, Convatec, and Smith & Nephew and receives research support from Smith & Nephew and Zimmer. Dr. Sculco receives research support from Exactech.The authors declare no conflicts of interest.

    • Presented in part at the annual meeting of the American Society of Anesthesiologists, New Orleans, Louisiana, 2009.