Risk factors for pain after total hip arthroplasty: a systematic review

Abstract

Background Approximately 23% of patients develop hip pain after total hip arthroplasty (THA). In this systematic review, we aimed to identify risk factors associated with postoperative pain after THA to optimize preoperative surgical planning. Methods Six literature databases were searched for articles published from January 1995 to August 2020. Controlled trials and observational studies that reported measurements of postoperative pain with assessments of preoperative modifiable and non-modifiable risk factors were included. Three researchers performed a literature review independently. Results Fifty-four studies were included in the study for analysis. The most consistent association between worse pain outcomes and the female sex is poor preoperative pain or function, and more severe medical or psychiatric comorbidities. The correlation was less strong between worse pain outcomes and preoperative high body mass index value, low radiographic grade arthritis, and low socioeconomic status. A weak correlation was found between age and worse pain outcomes. Conclusions Preoperative risk factors that were consistently predictive of greater/server postoperative pain after THA were identified, despite the varying quality of studies that prohibited the arrival of concrete conclusions. Modifiable factors should be optimized preoperatively, whereas non-modifiable factors may be valuable to patient education, shared decision-making, and individualized pain management.

Preoperative Risk Factors for Pain After Reverse Total Shoulder Arthroplasty: A Systematic Review

“…Similar results were found for preoperative BMI, with no statistically significant difference in pain following rTSA across varying BMIs as well as patient sex. The lack of association with BMI seems to reflect previous studies, which have shown improvements in pain are similar among patients following arthroplasty procedures across a variety of joints regardless of BMI, including total knee arthroplasty [48] as well as hip arthroplasty [9]. These preoperative factors showing little association with postoperative pain provide further evidence for rTSA being an efficacious intervention for a wide spectrum of patient demographics.…”

Comparison of fascia iliaca block with quadratus lumborum block for hip arthroplasty: A meta-analysis of randomized controlled trials

“…Many patients suffer from obvious pain after hip arthroplasty and increasing interest is focused on its perioperative analgesia in order to promote early postoperative mobilization and discharge. [ 1 – 3 ] Perioperative pain control is of utmost importance for patients’ recovery and satisfaction. [ 4 , 5 ] Perioperative analgesia is able to reduce opioid consumption, improve immediate postoperative function, and patient satisfaction.…”

Postoperative pain trajectories in total hip arthroplasty

“…While THA is generally a highly successful procedure, there remains significant variability in postoperative pain recovery. 1 Studies indicate that about 23% of patients may encounter postoperative hip pain, 2 - 5 with a subset even reporting stagnation or exacerbation of pain following the procedure. 4 While loosening of implants, infections, periprosthetic fractures, and soft-tissue abnormalities are recognized causes of postoperative pain, 3 numerous instances lack a clear correlation with radiological or mechanical irregularities.…”

“… 4 While loosening of implants, infections, periprosthetic fractures, and soft-tissue abnormalities are recognized causes of postoperative pain, 3 numerous instances lack a clear correlation with radiological or mechanical irregularities. 1 …”