Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants

Area of Science:

• Orthopedics
• Pain Medicine
• Rehabilitation

Background:

• Persistent postsurgical pain is a common yet often overlooked issue after joint replacement.
• Understanding its prevalence and characteristics is crucial for patient outcomes.

Purpose of the Study:

• To determine the prevalence, sensory qualities, and postoperative factors influencing persistent pain after total knee replacement (TKR) and total hip replacement (THR).

Main Methods:

• A questionnaire-based study involving 632 TKR and 662 THR patients 3-4 years post-surgery.
• Utilized validated instruments including WOMAC, PainDetect, and Short-Form McGill Pain Questionnaires.
• Assessed general health and socioeconomic status.

Main Results:

• 44% of TKR and 27% of THR patients reported persistent pain; 15% (TKR) and 6% (THR) experienced severe-extreme pain.
• Pain was typically aching, tender, or tiring; neuropathic pain was rare (6% TKR, 1% THR).
• Major depression and pre-existing pain problems independently predicted persistent pain.

Conclusions:

• Persistent postsurgical pain is prevalent after TKR and THR, though often mild.
• Severe persistent pain is associated with depression and a history of multiple pain conditions, suggesting a potential underlying pain vulnerability.
• Targeting depression and managing comorbid pain conditions may be important for at-risk patients.