Differences in outcomes after total hip arthroplasty for osteoarthritis between patients with and without central sensitivity syndromes other than fibromyalgia

Abstract

We investigated the differences in outcomes after total hip arthroplasty (THA) for hip osteoarthritis (HOA) between patients with and without central sensitivity syndromes (CSSs) other than fibromyalgia (FM). After excluding two patients with FM, we compared the clinical data of 41 patients with CSSs and 132 patients without CSSs. Clinical data included scores on the central sensitization inventory, visual analog scale for pain (VAS pain), and Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ). VAS pain was significantly higher at 3 and 6 months after THA in patients with CSSs than in those without CSSs (3 and 6 months, P < 0.001). Satisfaction, pain, and mental JHEQ scores were lower in patients with CSSs than in those without CSSs (satisfaction, P < 0.001; pain, P = 0.011; mental, P = 0.032). Multiple regression analyses indicated that one and ≥ 2 CSS diagnoses significantly impacted the satisfaction score (one CSS, β = − 0.181, P = 0.019; ≥ 2 CSSs, β = − 0.175, P = 0.023). Two or more CSSs were the only factor influencing the pain score (β = − 0.175, P = 0.027). Pain in patients with CSSs reflects central sensitization, which may adversely affect post-operative outcomes. Surgeons should pay attention to patients with a history of CSSs diagnoses who undergo THA for HOA.

Mechanisms of Peripheral and Central Sensitization in Osteoarthritis Pain

“…Indeed, several studies report that the association between radiographic structural changes and pain levels in OA is poor [3,4]. OA pain is subjective, involving both peripheral and central neural mechanisms, which are modulated not only by a wide range of neurochemical factors but additionally by environmental, psychological, and genetic factors [5][6][7]. Nevertheless, the mechanisms of OA pain are not well understood.…”