Skip to main content

Course of pain after total hip arthroplasty within a standardized pain management concept: a prospective study examining influence, correlation, and outcome of postoperative pain on 103 consecutive patients

Archives of Orthopaedic and Trauma Surgery volume 138, pages 1639–1645 (2018)Cite this article

Abstract

Introduction

Postoperative pain management options are of great importance for patients undergoing total hip arthroplasty, as joint replacement surgery is reported to be one of the most painful surgical procedures. This study demonstrates pain outcome until 4 weeks postoperatively and evaluates factors influencing pain in the postoperative course after total hip arthroplasty.

Materials and methods

A total of 103 patients were included in this prospective cohort trial and underwent total hip arthroplasty. Postoperative pain was described using a numerical rating scale (NRS); demographic data and perioperative parameters were correlated with postoperative pain.

Results

Evaluation of pain scores in the postoperative course showed a constant decrease in the first postoperative week (mean NRS 3.1 on day 1 to mean NRS 2.3 on day 8) and, then, a perpetual increase for 3 days (mean NRS 2.6 on day 9 to mean NRS 2.3 on day 12). Afterwards, a continuous pain-level decrease was stated (continuous to a mean NRS 0.9 on day 29). No correlation was found between the potential influencing factors sex, age, body mass index, duration of surgery, ASA score, and postoperative pain levels, but a high significant correlation could be stated for preoperative pain levels and postoperative pain intensity (pain while moving p < 0.02 to p < 0.05 depending on the time period “week 1 postoperatively”, “week 2–4”, or “week 1–4”; pain while resting p < 0.001, in all the measured time intervals, respectively).

Conclusion

Increasing pain levels after the first week postoperatively, for 3 days, are most likely to be caused by the change to more extensive mobilization and physiotherapy in the rehabilitation unit. No significant influence or correlation on the intensity of postoperative pain could be found while evaluating potential predictors except preoperative pain levels. Pain management has to take these findings into account in the future to further increase patients’ satisfaction in the postoperative course after total hip arthroplasty and to adapt pain management programs.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Karlson EW, Daltroy LH, Liang MH, Eaton HE, Katz JN (1997) Gender differences in patient preferences may underlie differential utilization of elective surgery. Am J Med 102(6):524–530

    CAS  Article  Google Scholar 

  2. Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, Peelen LM, Kappen TH, van Wijck AJ, Kalkman CJ, Meissner W (2014) Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology 120(5):1237–1245. https://doi.org/10.1097/ALN.0000000000000108

    Article  PubMed  Google Scholar 

  3. Wylde V, Sayers A, Lenguerrand E, Gooberman-Hill R, Pyke M, Beswick AD, Dieppe P, Blom AW (2015) Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis. Pain 156(1):47–54. https://doi.org/10.1016/j.pain.0000000000000002

    Article  PubMed  Google Scholar 

  4. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P (2012) What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2(1):e000435. https://doi.org/10.1136/bmjopen-2011-000435

    Article  PubMed  PubMed Central  Google Scholar 

  5. Greimel F, Maderbacher G, Zeman F, Grifka J, Meissner W, Benditz A (2017) No clinical difference comparing general, regional, and combination anesthesia in hip arthroplasty: a multicenter cohort-study regarding perioperative pain management and patient satisfaction. J Arthroplast 32(11):3429–3433. https://doi.org/10.1016/j.arth.2017.05.038

    Article  Google Scholar 

  6. Fikentscher T, Grifka J, Benditz A (2015) Perioperative pain therapy in orthopedics. Orthopade 44(9):727–740. https://doi.org/10.1007/s00132-015-3152-6

    CAS  Article  PubMed  Google Scholar 

  7. Lenguerrand E, Wylde V, Gooberman-Hill R, Sayers A, Brunton L, Beswick AD, Dieppe P, Blom AW (2016) Trajectories of pain and function after primary hip and knee arthroplasty: the ADAPT cohort study. PLoS One 11(2):e0149306. https://doi.org/10.1371/journal.pone.0149306

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86-A(5):963–974

    Article  Google Scholar 

  9. Bachmeier CJ, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtenay BG, Brooks PM, Arthritis C, Outcome Project G (2001) A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthr Cartil 9(2):137–146

    CAS  Article  Google Scholar 

  10. Browne JP, Bastaki H, Dawson J (2013) What is the optimal time point to assess patient-reported recovery after hip and knee replacement? A systematic review and analysis of routinely reported outcome data from the English patient-reported outcome measures programme. Health Qual Life Outcomes 11:128. https://doi.org/10.1186/1477-7525-11-128

    Article  PubMed  PubMed Central  Google Scholar 

  11. Halket A, Stratford PW, Kennedy DM, Woodhouse LJ (2010) Using hierarchical linear modeling to explore predictors of pain after total hip and knee arthroplasty as a consequence of osteoarthritis. J Arthroplast 25(2):254–262. https://doi.org/10.1016/j.arth.2009.01.007

    Article  Google Scholar 

  12. Fitzgerald JD, Orav EJ, Lee TH, Marcantonio ER, Poss R, Goldman L, Mangione CM (2004) Patient quality of life during the 12 months following joint replacement surgery. Arthritis Rheum 51(1):100–109. https://doi.org/10.1002/art.20090

    Article  PubMed  Google Scholar 

  13. Kennedy DM, Stratford PW, Hanna SE, Wessel J, Gollish JD (2006) Modeling early recovery of physical function following hip and knee arthroplasty. BMC Musculoskelet Disord 7:100. https://doi.org/10.1186/1471-2474-7-100

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kennedy DM, Stratford PW, Riddle DL, Hanna SE, Gollish JD (2008) Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther 88(1):22–32. https://doi.org/10.2522/ptj.20070051

    Article  PubMed  Google Scholar 

  15. Naylor JM, Harmer AR, Heard RC, Harris IA (2009) Patterns of recovery following knee and hip replacement in an Australian cohort. Aust Health Rev 33(1):124–135

    Article  Google Scholar 

  16. Davis AM, Perruccio AV, Ibrahim S, Hogg-Johnson S, Wong R, Streiner DL, Beaton DE, Cote P, Gignac MA, Flannery J, Schemitsch E, Mahomed NN, Badley EM (2011) The trajectory of recovery and the inter-relationships of symptoms, activity and participation in the first year following total hip and knee replacement. Osteoarthr Cartil 19(12):1413–1421. https://doi.org/10.1016/j.joca.2011.08.007

    CAS  Article  Google Scholar 

  17. Hamilton D, Henderson GR, Gaston P, MacDonald D, Howie C, Simpson AH (2012) Comparative outcomes of total hip and knee arthroplasty: a prospective cohort study. Postgrad Med J 88(1045):627–631. https://doi.org/10.1136/postgradmedj-2011-130715

    Article  PubMed  Google Scholar 

  18. Kennedy DM, Hanna SE, Stratford PW, Wessel J, Gollish JD (2006) Preoperative function and gender predict pattern of functional recovery after hip and knee arthroplasty. J Arthroplast 21(4):559–566. https://doi.org/10.1016/j.arth.2005.07.010

    Article  Google Scholar 

  19. Kennedy DM, Stratford PW, Robarts S, Gollish JD (2011) Using outcome measure results to facilitate clinical decisions the first year after total hip arthroplasty. J Orthop Sports Phys Ther 41(4):232–239. https://doi.org/10.2519/jospt.2011.3516

    Article  PubMed  Google Scholar 

  20. Judge A, Cooper C, Williams S, Dreinhoefer K, Dieppe P (2010) Patient-reported outcomes one year after primary hip replacement in a European Collaborative Cohort. Arthritis Care Res (Hoboken) 62(4):480–488. https://doi.org/10.1002/acr.20038

    Article  Google Scholar 

  21. Davis AM, Agnidis Z, Badley E, Kiss A, Waddell JP, Gross AE (2006) Predictors of functional outcome two years following revision hip arthroplasty. J Bone Joint Surg Am 88(4):685–691. https://doi.org/10.2106/JBJS.E.00150

    Article  PubMed  Google Scholar 

  22. Schrader P, Boy O, Schleiz W, Dienst R, Reinert C, Sanger V, Schauwecker HH, Siebert W, Scharf HP (2008) Determining the indication for primary total hip and knee replacement. Results of external quality assurance of over 270,000 primary total hip and knee replacements. Orthopade 37(10):1016–1026. https://doi.org/10.1007/s00132-008-1341-2

    CAS  Article  PubMed  Google Scholar 

  23. Mannion AF, Impellizzeri FM, Naal FD, Leunig M (2015) Women demonstrate more pain and worse function before THA but comparable results 12 months after surgery. Clin Orthop Relat Res 473(12):3849–3857. https://doi.org/10.1007/s11999-015-4479-3

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wiesenfeld-Hallin Z (2005) Sex differences in pain perception. Gend Med 2(3):137–145

    Article  Google Scholar 

  25. Oak SR, Strnad GJ, O’Rourke C, Higuera CA, Spindler KP, Brooks PJ (2017) Mid-term results and predictors of patient-reported outcomes of Birmingham hip resurfacing. J Arthroplast 32(1):110–118. https://doi.org/10.1016/j.arth.2016.06.049

    Article  Google Scholar 

  26. Lungu E, Vendittoli PA, Desmeules F (2015) Identification of patients with suboptimal results after hip arthroplasty: development of a preliminary prediction algorithm. BMC Musculoskelet Disord 16:279. https://doi.org/10.1186/s12891-015-0720-1

    Article  PubMed  PubMed Central  Google Scholar 

  27. Henderson LA, Gandevia SC, Macefield VG (2008) Gender differences in brain activity evoked by muscle and cutaneous pain: a retrospective study of single-trial fMRI data. Neuroimage 39(4):1867–1876. https://doi.org/10.1016/j.neuroimage.2007.10.045

    Article  PubMed  Google Scholar 

  28. Hallin RG (2003) Pain more painful in women. Gender perspective neglected in research on the biological mechanisms of pain. Lakartidningen 100(46):3738–3741

    PubMed  Google Scholar 

  29. Caicedo MS, Solver E, Coleman L, Jacobs JJ, Hallab NJ (2017) Females with unexplained joint pain following total joint arthroplasty exhibit a higher rate and severity of hypersensitivity to implant metals compared with males: implications of sex-based bioreactivity differences. J Bone Joint Surg Am 99(8):621–628. https://doi.org/10.2106/JBJS.16.00720

    Article  PubMed  Google Scholar 

  30. Creamer P, Hochberg MC (1997) Osteoarthr Lancet 350(9076):503–508. https://doi.org/10.1016/S0140-6736(97)07226-7

    CAS  Article  Google Scholar 

  31. Paladini A, Fusco M, Coaccioli S, Skaper SD, Varrassi G (2015) Chronic pain in the elderly: the case for new therapeutic strategies. Pain Physician 18(5):E863–E876

    PubMed  Google Scholar 

  32. Richmond SA, Fukuchi RK, Ezzat A, Schneider K, Schneider G, Emery CA (2013) Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review. J Orthop Sports Phys Ther 43(8):515–519. https://doi.org/10.2519/jospt.2013.4796

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany

    Felix Greimel, Gregor Dittrich, Timo Schwarz, Moritz Kaiser, Bernd Krieg, Joachim Grifka & Achim Benditz

  2. Center for Clinical Studies, University Medical Center of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

    Florian Zeman

Authors
  1. Felix Greimel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregor Dittrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Timo Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Moritz Kaiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernd Krieg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Florian Zeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joachim Grifka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Achim Benditz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors made contributions to the interpretation of data and have been involved in drafting the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Felix Greimel.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical standards

The study was approved by the local Ethics Committee with the approval number 16-101-0204 (IRB approval). Furthermore, the project was registered in the German Registry of Clinical Studies (DRKS) with the approval number DRKS00011803 (WHO register). The study was applied in accordance with the ethical standards of the Declaration of Helsinki 1975.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Greimel, F., Dittrich, G., Schwarz, T. et al. Course of pain after total hip arthroplasty within a standardized pain management concept: a prospective study examining influence, correlation, and outcome of postoperative pain on 103 consecutive patients. Arch Orthop Trauma Surg 138, 1639–1645 (2018). https://doi.org/10.1007/s00402-018-3014-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-018-3014-x

Keywords

  • Postoperative pain
  • Total hip arthroplasty
  • Pain management
  • Body mass index
  • Age
  • Duration of surgery