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Persistent pain after joint replacement: Prevalence, sensory qualities, and postoperative determinants

Wylde, Vikkia,*; Hewlett, Sarahb; Learmonth, Ian D.a; Dieppe, Paulc

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doi: 10.1016/j.pain.2010.11.023
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Persistent postsurgical pain is a prevalent but underacknowledged condition. The aim of this study was to assess the prevalence, sensory qualities, and postoperative determinants of persistent pain at 3 to 4 years after total knee replacement (TKR) and total hip replacement (THR). Patients completed a questionnaire with included the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) Pain Scale, PainDetect Questionnaire, Short-Form McGill Pain Questionnaire, and questions about general health and socioeconomic status. A total of 632 TKR patients and 662 THR patients completed a questionnaire (response rate of 73%); 44% of TKR patients and 27% of THR patients reported experiencing persistent postsurgical pain of any severity, with 15% of TKR patients and 6% of THR patients reporting severe-extreme persistent pain. The persistent pain was most commonly described as aching, tender, and tiring, and only 6% of TKR patients and 1% of THR patients reported pain that was neuropathic in nature. Major depression and the number of pain problems elsewhere were found to be significant and independent postoperative determinants of persistent postsurgical pain. In conclusion, this study found that persistent postsurgical pain is common after joint replacement, although much of the pain is mild, infrequent, or an improvement on preoperative pain. The association between the number of pain problems elsewhere and the severity of persistent postsurgical pain suggests that patients with persistent postsurgical pain may have an underlying vulnerability to pain.

A small percentage of patients have severe persistent pain after joint replacement, and this is associated with depression and the number of pain problems elsewhere.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

aUniversity of Bristol, Musculoskeletal Research Unit, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK

bUniversity of the West of England, Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, UK

cPeninsula Medical School, Plymouth, UK

*Corresponding author. Address: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, UK. Tel.: +44 117 323 5906; fax: +44 117 323 5936.

E-mail: V.Wylde@bristol.ac.uk

Submitted September 30, 2010; revised November 15, 2010; accepted November 19, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.
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