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Review
. 2023 Jan 10;8(1):e1052.
doi: 10.1097/PR9.0000000000001052. eCollection 2023 Jan.

Factors associated with persistent postsurgical pain after total knee or hip joint replacement: a systematic review and meta-analysis

Arunangshu Ghoshal  1 , Shivam Bhanvadia  2 , Som Singh  3 , Lauren Yaeger  4 , Simon Haroutounian  5
Affiliations
Review

Factors associated with persistent postsurgical pain after total knee or hip joint replacement: a systematic review and meta-analysis

Arunangshu Ghoshal et al. Pain Rep. .

Abstract

Studies have identified demographic, clinical, psychosocial, and perioperative variables associated with persistent pain after a variety of surgeries. This study aimed to perform a systematic review and meta-analysis of factors associated with persistent pain after total knee replacement (TKR) and total hip replacement (THR) surgeries. To meet the inclusion criteria, studies were required to assess variables before or at the time of surgery, include a persistent postsurgical pain (PPSP) outcome measure at least 2 months after a TKR or THR surgery, and include a statistical analysis of the effect of the risk factor(s) on the outcome measure. Outcomes from studies implementing univariate and multivariable statistical models were analyzed separately. Where possible, data from univariate analyses on the same factors were combined in a meta-analysis. Eighty-one studies involving 171,354 patients were included in the review. Because of the heterogeneity of assessment methods, only 44% of the studies allowed meaningful meta-analysis. In meta-analyses, state anxiety (but not trait anxiety) scores and higher depression scores on the Beck Depression Inventory were associated with an increased risk of PPSP after TKR. In the qualitative summary of multivariable analyses, higher preoperative pain scores were associated with PPSP after TKR or THR. This review systematically assessed factors associated with an increased risk of PPSP after TKR and THR and highlights current knowledge gaps that can be addressed by future research.

Keywords: Chronic postsurgical pain; Hip replacement; Knee replacement; Meta-analysis; Persistent postsurgical pain; Systematic review.

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Conflict of interest statement

S. Haroutounian reports research grants from Disarm Therapeutics and personal fees from Rafa Laboratories and Vertex Pharmaceuticals, outside the scope of this paper. The remaining authors have no conflicts of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart.
Figure 2.
Figure 2.
Forest plot for the association between age and PPSP in total knee joint replacement surgeries analyzed together. *Higher/positive SMD represents the difference in age (in years) between patients who developed PPSP vs those who did not, the horizontal box and whisker plots are the group SMDs ±95% confidence intervals, and the blue diamond is the combined SMD of groups.
Figure 3.
Figure 3.
Forest plot for the association between the proportion of women in the study population and PPSP in total knee joint replacement surgeries. *Risk ratio (RR) >1 represents higher, RR <1 represents lesser, while RR = 1 represents a similar occurrence of PPSP in women compared with the study population, the horizontal box and whisker plots are the group RRs ±95% confidence intervals, and the blue diamond is the combined RR of groups.
Figure 4.
Figure 4.
Forest plot for the association between age and PPSP in total knee and hip joint replacement surgeries analyzed together. *Higher/positive SMD represents the difference in age (in years) between patients who developed PPSP vs those who did not, the horizontal box and whisker plots are the group SMDs ±95% confidence intervals, and the blue diamond is the combined SMD of groups.
Figure 5.
Figure 5.
Forest plot for the association between body mass index (BMI) in kg/m2 and PPSP in total knee joint replacement surgeries analyzed together. *Higher/positive SMD represents the difference in BMI units between patients who developed PPSP vs those who did not, the horizontal box and whisker plots are the group SMDs ±95% confidence intervals, and the blue diamond is the combined SMD of groups.
Figure 6.
Figure 6.
Forest plot for the association between state anxiety and PPSP in total knee joint replacement surgeries analyzed together. *Higher/positive SMD represents the difference in the state anxiety score between patients who developed PPSP vs those who did not, the horizontal box and whisker plots are the group SMDs ±95% confidence intervals, and the blue diamond is the combined SMD of groups.
Figure 7.
Figure 7.
Forest plot for the association between depression scored in the Beck Depression Inventory (0–39) and PPSP in total knee joint replacement surgeries was analyzed together. *Higher/positive SMD represents the difference in depression scored in the Beck Depression Inventory (score range 0–39) units between patients who developed PPSP vs those who did not, the horizontal box and whisker plots are the group SMDs ±95% confidence intervals, and the blue diamond is the combined SMD of groups.
Figure 8.
Figure 8.
Forest plot for the association between preoperative numerical rating scale pain score (0–10) and PPSP in total knee joint replacement surgeries analyzed together. *Higher/positive SMD represents the difference in preoperative numerical rating scale pain score (0–10) units between patients who developed PPSP vs those who did not, the horizontal box and whisker plots are the group SMDs ±95% confidence intervals, and the blue diamond is the combined SMD of groups.
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