Neuropathic-Like Symptoms as Preoperative Predictor for Chronic Postsurgical Pain and Dissatisfaction in Total Hip and Knee Arthroplasty Patients

Abstract

Abstract Background A significant portion of total knee and hip arthroplasty (TKA/THA) patients experience chronic postsurgical pain (CPSP). The proportion of suffering patients runs in the 10–34% range. 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). Preoperatively, pain intensity (numeric rating scale [NRS]) and neuropathic-like symptoms (modified-painDETECT questionnaire [mPDQ]; score ≥ 13) were obtained. One year postoperatively CPSP and dissatisfaction (single NRS item (0–10); dissatisfied: ≤ 5) was 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 knee and hip patients separately. Results The odds (p < 0.05) of experiencing CPSP at one year ranged from 2.16 (total group) to 4.15 (hip patients) for patients that experienced neuropathic-like symptoms preoperatively (m-PDQ ≥ 13). Neuropathic-like symptoms had no additional value for predicting CPSP in knee patients nor 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.