Prognostics for pain in osteoarthritis: Do clinical measures predict pain after total joint replacement?

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Pain Management*; Osteoarthritis, Hip/*surgery ; Osteoarthritis, Knee/*surgery ; Pain, Postoperative/*therapy; Aged ; Arthroplasty, Replacement/adverse effects ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/methods ; Arthroplasty, Replacement, Knee/adverse effects ; Arthroplasty, Replacement, Knee/methods ; Female ; Humans ; Knee Joint/physiopathology ; Knee Joint/surgery ; Male ; Middle Aged ; Osteoarthritis, Hip/physiopathology ; Osteoarthritis, Knee/physiopathology ; Pain Measurement/methods ; Pain, Postoperative/epidemiology ; Pain, Postoperative/physiopathology ; Severity of Illness Index

A significant proportion of osteoarthritis (OA) patients continue to experience moderate to severe pain after total joint replacement (TJR). Preoperative factors related to pain persistence are mainly studied using individual predictor variables and distinct pain outcomes, thus leading to a lack of consensus regarding the influence of preoperative parameters on post-TJR pain. In this prospective observational study, we evaluated knee and hip OA patients before, 3 and 6 months post-TJR searching for clinical predictors of pain persistence. We assessed multiple measures of quality, mood, affect, health and quality of life, together with radiographic evaluation and performance-based tasks, modeling four distinct pain outcomes. Multivariate regression models and network analysis were applied to pain related biopsychosocial measures and their changes with surgery. A total of 106 patients completed the study. Pre-surgical pain levels were not related to post-surgical residual pain. Although distinct pain scales were associated with different aspects of post-surgical pain, multi-factorial models did not reliably predict post-surgical pain in knee OA (across four distinct pain scales) and did not generalize to hip OA. However, network analysis showed significant changes in biopsychosocial-defined OA personality post-surgery, in both groups. Our results show that although tested clinical and biopsychosocial variables reorganize after TJR in OA, their presurgical values are not predictive of post-surgery pain. Derivation of prognostic markers for pain persistence after TJR will require more comprehensive understanding of underlying mechanisms.
Competing Interests: The authors have declared that no competing interests exist.

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P50 DA044121 United States DA NIDA NIH HHS; R01 AR074274 United States AR NIAMS NIH HHS

Date Created: 20200109 Date Completed: 20200401 Latest Revision: 20201118

20240105

PMC6948829

10.1371/journal.pone.0222370

31914126