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

Abstract

Background

Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes. However, some people experience long-term pain.

Objectives

To review published studies in representative populations with total hip or knee replacement for the treatment of osteoarthritis reporting proportions of people by pain intensity.

Data sources

MEDLINE and EMBASE databases searched to January 2011 with no language restrictions. Citations of key articles in ISI Web of Science and reference lists were checked.

Study eligibility criteria, participants and interventions

Prospective studies of consecutive, unselected osteoarthritis patients representative of the primary total hip or knee replacement population, with intensities of patient-centred pain measured after 3 months to 5-year follow-up.

Study appraisal and synthesis methods

Two authors screened titles and abstracts. Data extracted by one author were checked independently against original articles by a second. For each study, the authors summarised the proportions of people with different severities of pain in the operated joint.

Results

Searches identified 1308 articles of which 115 reported patient-centred pain outcomes. Fourteen articles describing 17 cohorts (6 with hip and 11 with knee replacement) presented appropriate data on pain intensity. The proportion of people with an unfavourable long-term pain outcome in studies ranged from about 7% to 23% after hip and 10% to 34% after knee replacement. In the best quality studies, an unfavourable pain outcome was reported in 9% or more of patients after hip and about 20% of patients after knee replacement.

Limitations

Other studies reported mean values of pain outcomes. These and routine clinical studies are potential sources of relevant data.

Conclusions and implications of key findings

After hip and knee replacement, a significant proportion of people have painful joints. There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes.

Article summary

Article focus

• Total hip and knee replacement have good clinical outcomes.

• There is a perception that some people experience long-term pain after their joint replacement.

• We aim to establish the proportion of patients experiencing long-term pain after joint replacement.

Key messages

• Well-conducted studies in representative populations of patients with total hip and knee joint replacement suggest that a significant proportion of people continue to have painful joints after surgery.

• The proportion of people with an unfavourable long-term pain outcome in studies ranged from about 7% to 23% after hip and 10% to 34% after knee replacement. In the best quality studies, an unfavourable pain outcome was reported in 9% or more of patients after total hip and about 20% of patients after total knee replacement.

• There is an urgent need to improve general awareness that some patients experience long-term pain after joint replacement and to address the determinants of good and bad outcomes.

Strengths and limitations of this study

• Systematic review conducted according to established methods and guidelines identified 17 studies in representative populations of patients with total hip or knee replacement.

• Pain outcome data are widely recorded as mean values but only a minority of studies reported outcomes as proportions with pain at follow-up.

• The small number of studies and different pain outcome measures precluded meta-analysis, calculation of a summary estimate and exploration of sources of heterogeneity.