High-impact chronic pain after total joint arthroplasty: a longitudinal cohort study

High-impact chronic pain (HICP) is associated with impaired function, diminished quality of life, and greater healthcare utilization. Although total joint arthroplasty (TJA) is effective for osteoarthritis, up to 20% of patients report persistent pain and limitations.

To examine transitions in HICP status and identify predictors of postoperative HICP following TJA.

This was a retrospective longitudinal cohort study of 6631 patients who underwent total knee (46.6%), hip (31.2%), or shoulder (22.2%) arthroplasty at a large US academic medical center between January 2018 and August 2024. Transitions in HICP status were described, and multivariable logistic regression was used to evaluate predictors of postoperative HICP. Results were reported as odds ratios (OR) with 95% confidence intervals (CI). Model performance was assessed using classification accuracy, receiver operating characteristic analysis, and the area under the curve.

Preoperatively, 45.3% of patients reported HICP, which declined to 15.2% after surgery. However, 4.8% developed new-onset HICP, yielding an overall postoperative prevalence of 20.0%. Preoperative HICP (OR = 2.50, 95% CI: 2.10-2.94), lower physical function (OR = 0.95, 95% CI: 0.93-0.96), higher pain intensity (OR = 1.07, 95% CI: 1.04-1.10), and postoperative opioid exposure (OR = 1.83, 95% CI: 1.59-2.11) were the strongest predictors. Additional factors included younger age, sex, alcohol use, revision surgery, and comorbidity burden.

Although TJA substantially reduces HICP prevalence, 1 in 5 patients continues to experience significant postoperative pain. Early identification of at-risk individuals and the integration of targeted perioperative interventions are critical to optimize recovery and long-term outcomes.