Perioperative prevention of persistent pain after total hip and knee arthroplasty—Protocol for two systematic reviews

Abstract

Background: Between 9% and 20% of patients experience moderate to severe persistent postoperative pain after total hip or knee arthroplasty. Severe immediate postoperative pain limits rehabilitation and is associated with the development of persistent postoperative pain. Therefore, perioperative analgesic and physiotherapeutic interventions are of interest to reduce persistent pain. In two systematic reviews with identical methodology, we aim to investigate the effects of (a) perioperative analgesic interventions and (b) physiotherapeutic interventions in reducing persistent pain after total hip and knee arthroplasty.Methods: We will include randomised and cluster-randomised controlled trials on perioperative analgesic and physiotherapeutic interventions for patients undergoing elective total hip or knee arthroplasty for osteoarthritis. After contact with the authors, trials without pain data 3-24 months postoperatively will be excluded.Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and reference lists will be searched for eligible trials. Two authors will independently screen, extract data and assess the risk of bias. The primary outcome is pain scores 3-24 months postoperatively. Meta-analyses will be performed for interventions with two or more trials. We will conduct trial sequential analyses and assign Grading of Recommendations, Assessment, Development and Evaluation (GRADE) ratings. Conclusion:No previous review on reduction of persistent postoperative pain has included non-pharmacological or invasive analgesic techniques. These two reviews with identical methodology will summarise the evidence of analgesic and physiotherapeutic perioperative interventions to prevent persistent pain.

Osteoarthritis as an Umbrella Term for Different Subsets of Humans Undergoing Joint Degeneration: The Need to Address the Differences to Develop Effective Conservative Treatments and Prevention Strategies

“…Pain severity can increase during disease progression, possibly due to epigenetic alterations [ 24 ]. In fact, approximately 20% of patients receiving joint arthroplasty for their OA have persistent pain after the surgery for mainly unknown reasons [ 25 , 26 , 27 ]. Due to the complexity of the interface between pain, chronic pain and persistent pain and the structural alterations associated with OA progression and treatment, this review will focus on subtypes of knee OA but not on the correlations with pain or pain mechanisms.…”

The Impact of Acute Postoperative Pain in Developing Chronic Pain after Total Knee Arthroplasty

“…Although most patients eventually endorse satisfaction with their TKA, undergoing the procedure has been shown to cause significant APSP [26]. Approximately 25% of TKA patients report persistent postsurgical pain, with 9-20% experiencing severe pain [27,28]. Significant predictors of CPSP when looking at TKA patients include moderate-to-severe APSP, younger age, and pain catastrophizing [29].…”