Background Total hip or knee replacement (THR, TKR) improve pain, function and quality of life of many individuals with moderate to severe osteoarthritis (OA). Pain is the main reason for patients undergoing these procedures and therefore recurrence and/or persistence of significant pain after is of great concern. While several important unmodifiable patient characteristics such as age and gender can impact pain outcomes, it is important to know whether modifiable factors impact pain following the surgery.
Objectives To systematically analyze the evidence regarding to preoperative predictors of postoperative pain in patients with OA undertaking TKR and/or THR.
Methods A systematic literature review (SLR) was performed. Studies were identified by sensitive search strategies in the main bibliographic databases (Medline, Embase and Cochrane Library) up to May 2013. Mesh terms and text word were used. We selected articles that analyzed, in OA patients who undertook TKR and/or THR, the impact of preoperative factors on postoperative pain including: age, sex, educational level, socioeconomic status, race, profession, disease duration, comorbidities, body mass index, quality of life, preoperative pain, self-management, surgery (prosthesis devices types, anaesthesia, implant fixation, etc), surgeon characteristics, surgery waiting list, hospital features, patient expectations, depression, anxiety, etc. Any type of study except case series or case reports was eligible. Two reviewers (CH and MLB) screened the titles and abstracts of the retrieved articles independently. EL reviewed the selected articles in detail and collected data from the studies by using ad hoc standard forms. A hand search was completed by reviewing the references of the included studies. An ad hoc risk of bias scale was used. Quality was graded using the Oxford Centre for Evidence-based Medicine Levels of Evidence for descriptive/prognostic questions.
Results We selected 37 studies (4 SLR, 1 randomized controlled trial, 32 longitudinal studies), of moderate quality. Included patients were representative of those undergoing these surgical procedures. We found a great variability regarding type of studies and preoperative factors (including their definitions). In most of studies pain was evaluated using the WOMAC questionnaire. There was a strong association (and consistent through studies) between worse postoperative pain and female sex, low socioeconomic status, poor preoperative pain, poor functional status, and psychological factors (depression, anxiety, pain catastrophicing) and type of prosthesis (cementless fixation). BMI was found as a predictor but only for those with severe obesity. Comorbidity was also a predictor but for those with more number of comorbidities. Race (afroamericans), back pain, poor functional status prior to surgery, type of prosthesis and waiting list were predictors as well but based on few studies.
Conclusions In patients undergoing to a TKR or THR, there are preoperative factors that are associated with postoperative pain, and some of them can be modifiable. These factors should be carefully being evaluated when considering a TKR or THR in patients with OA.
Acknowledgements This proyect wasfunded by MSD.
Disclosure of Interest : None declared
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