Neuropathic-like symptoms have an additional predictive value for chronic postsurgical pain in total hip and knee arthroplasty patients

BACKGROUND: A significant portion of total knee and hip arthroplasty (TKA/THA) patients experience chronic postsurgical pain (CPSP). The prevalence of afflicted individuals ranges from 10 to 34%. CPSP is the main cause of postoperative dissatisfaction. For prevention purposes it is essential to know which preoperative factors are predictive for CPSP. It is unknown whether neuropathic-like symptoms add predictive value to known predictors for CPSP and dissatisfaction after TKA/THA.

METHODS: A prospective cohort study including 453 TKA/THA patients (TKA 208, THA 245) was conducted. Pain intensity (numeric rating scale [NRS]) and neuropathic-like symptoms (modified-painDETECT questionnaire [mPDQ]; score ≥ 13) were obtained preoperatively. One year postoperatively, CPSP and dissatisfaction (single NRS item (0-10); dissatisfied: ≤ 5) were captured: CPSP by means of the Oxford Knee/Hip Score (moderate or severe pain on question 1) as well by pain intensity at rest and with movement (NRS ≥ 1). Multivariate logistic regression modeling was used to determine the additive predictive value of preoperative neuropathic-like symptoms (mPDQ ≥ 13) on experiencing CPSP and dissatisfaction for the total group and for knee and hip patients separately.

RESULTS: Preoperative neuropathic-like symptoms (m-PDQ ≥ 13) had an additional value for experiencing CPSP after one year, with odds ratios (p < 0.05) ranging from 2.16 (total group) to 4.15 (hip patients). Neuropathic-like symptoms had no additional value for predicting CPSP in knee patients or for predicting dissatisfaction.

CONCLUSION: The results of this study showed that neuropathic-like symptoms (m-PDQ ≥ 13) have an additional predictive value over known predictors, especially in hip patients. Patients with neuropathic-like symptoms have over twice the odds of suffering from CPSP one year after TKA/THA. Neuropathic-like symptoms had no additional value for predicting dissatisfaction.