A survey of 2,638 Duke Health patients who had total replacement of knee, hip, or shoulder joints in 2014-20 found that approximately one-third experienced high-impact or bothersome chronic pain following the surgery.
Surgical reconstructions or replacements of the hip, knee, and shoulder—also known as arthroplasty—are among the most frequently performed orthopaedic procedures in the United States. A new paper examines the prevalence of high-impact and bothersome chronic postsurgical pain following these surgeries. This is the first time to the authors’ knowledge that this outcome has been analyzed for total joint arthroplasty based on chronic pain definitions advocated for by the Federal Pain Research Strategy.
Published online ahead of print by The Journal of Pain, the official journal of the U.S. Association for the Study of Pain, the survey revealed that following total joint arthroplasty, high-impact chronic pain occurred in around 10% of individuals and postoperative bothersome chronic pain was reported by some 25% of individuals.
“This new information on chronic pain following total joint replacement will help us develop decision support tools to inform patients and surgeons on the risk of high impact pain as a post-surgical outcome,” said lead author Steven Z. George PT, Ph.D., FAPTA. George is Vice Chair of Research and Laszlo Ormandy Distinguished Professor in Orthopaedic Surgery and Therapeutic Area Lead for Musculoskeletal and Surgical Sciences at the DCRI. He adds, “In this cohort, we found that more than one-third of individuals reported high-impact or bothersome chronic pain following total joint arthroplasty. Non-white race and receiving knee arthroplasty were the only two variables associated with both chronic pain outcomes.”
This retrospective observational study included 2,638 individuals who had a total joint arthroplasty at Duke Health between January 2014 and January 2020. Pre-operative and clinical encounter information was extracted from the electronic health record and chronic pain state was determined by responses to an email survey.
“As surgeons, we know that up to 20% of total knee replacement patients can be dissatisfied or have pain following the procedure,” said second author Michael P. Bolognesi, MD, professor of orthopedic surgery at Duke. “These findings will help us identify these patients more confidently before surgery, and – in an era of value-based care and bundled payment programs – will inform better post-operative treatment options as well as more accurate setting of targets for costs over their period of care.”
The study found that predictors of high-impact chronic pain included joint location, number of surgeries, comorbidities, tobacco use, BMI, and pre-operative pain intensity. The primary outcomes were high-impact and bothersome chronic pain. Rates of high-impact pain were comparable for knee (9.8%-13.3%), hip (8.3%-11.8%), and shoulder (7.6%-16.3%) arthroplasty. Increased risk of high-impact pain included non-white race, two or more comorbidities, age less than 65 years, pre-operative pain scores of 5/10 or higher, knee arthroplasty, and post-operative survey completion of 24 months or less.
Rates of bothersome chronic pain were also comparable for knee (24.9%-29.9%) and hip (21.3%-26.3%) arthroplasty, but higher for shoulder (26.9%-39.6%) arthroplasty. Increased risk of bothersome chronic pain included non-white race, shoulder arthroplasty, knee arthroplasty, current or past tobacco use, and being female. Higher preoperative comorbidity count was the only factor associated with increased risk of opioid use following total joint arthroplasty.
Other Duke authors of the paper were Nrupen A. Bhavsar, Ph.D.; Colin T. Penrose, MD; and the senior author was Maggie E. Horn DPT, MPH, Ph.D.