Warner SC, Richardson H, Jenkins W, Kurien T, Doherty M, Valdes AM. Neuropathic pain-like symptoms and pre-surgery radiographic severity contribute to patient satisfaction 4.8 years post-total joint replacement. World J Orthop 2017; 8(10): 761-769 [PMID: 29094006 DOI: 10.5312/wjo.v8.i10.761]
Corresponding Author of This Article
Sophie C Warner, PhD, Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Groby Road, Leicester LE3 9QP, United Kingdom. scw27@le.ac.uk
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Oct 18, 2017; 8(10): 761-769 Published online Oct 18, 2017. doi: 10.5312/wjo.v8.i10.761
Neuropathic pain-like symptoms and pre-surgery radiographic severity contribute to patient satisfaction 4.8 years post-total joint replacement
Sophie C Warner, Helen Richardson, Wendy Jenkins, Thomas Kurien, Michael Doherty, Ana M Valdes
Sophie C Warner, Helen Richardson, Wendy Jenkins, Michael Doherty, Ana M Valdes, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham NG5 1PB, United Kingdom
Sophie C Warner, Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Leicester LE3 9QP, United Kingdom
Thomas Kurien, Michael Doherty, Ana M Valdes, Arthritis Research UK Pain Centre, Nottingham NG5 1PB, United Kingdom
Thomas Kurien, Academic Division of Trauma and Orthopaedics, Queens Medical Centre, Nottingham NG7 2UH, United Kingdom
Author contributions: All authors have contributed to the conception and design of the study, the acquisition of data and/or the analysis and interpretation of the data; all authors read, provided critical feedback on intellectual content and approved the final manuscript.
Supported by PhD studentship awarded by the University of Nottingham (to Warner SC); EULAR project grant to AMV, No. 108239; ARUK Pain Centre, No. 18769.
Institutional review board statement: The North Nottinghamshire Research Ethics Committee approved the study protocol (REC number: 07/Q2501/22).
Informed consent statement: All participants gave written, informed consent prior to study inclusion.
Conflict-of-interest statement: The authors declare no relevant conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sophie C Warner, PhD, Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Groby Road, Leicester LE3 9QP, United Kingdom. scw27@le.ac.uk
Telephone: +44-116-2044778
Received: November 29, 2016 Peer-review started: December 2, 2016 First decision: February 17, 2017 Revised: June 20, 2017 Accepted: August 15, 2017 Article in press: August 16, 2017 Published online: October 18, 2017 Processing time: 322 Days and 9.9 Hours
Abstract
AIM
To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement (TJR) in people who had undergone knee or hip replacement for osteoarthritis.
METHODS
Participants (n = 1151) were recruited from Nottinghamshire post-total hip or knee replacement. Questionnaire assessment included medication use, the pain-DETECT questionnaire (PDQ) to assess neuropathic pain-like symptoms (NP) and TJR satisfaction measured on average 4.8 years post-TJR. Individual factors were tested for an association with post-TJR satisfaction, before incorporating all factors into a full model. Data reduction was carried out using LASSO and receiver operator characteristic (ROC) curve analysis was used to quantify the contribution of variables to post-TJR satisfaction.
RESULTS
After data reduction, the best fitting model for post-TJR satisfaction included various measures of pain, history of revision surgery, smoking, pre-surgical X-ray severity, WOMAC function scores and various comorbidities. ROC analysis of this model gave AUC = 0.83 (95%CI: 0.80-0.85). PDQ scores were found to capture much of the variation in post-TJR satisfaction outcomes: AUC = 0.79 (0.75-0.82). Pre-surgical radiographic severity was associated with higher post-TJR satisfaction: ORsatisfied = 2.06 (95%CI: 1.15-3.69), P = 0.015.
CONCLUSION
These results highlight the importance of pre-surgical radiographic severity, post-TJR function, analgesic medication use and NP in terms of post-TJR satisfaction. The PDQ appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction.
Core tip: The growing number of total joint replacement (TJR) surgeries performed worldwide every year means that research in this area has the potential to impact millions of people. These results highlight the importance of a number of factors with regards to post-TJR satisfaction. The pain-DETECT questionnaire for neuropathic pain-like symptoms (NP) appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction. Individuals with NP pre- or post-TJR could be indicated using this short questionnaire and referred for further testing and treatment to improve outcomes at every stage of their osteoarthritis treatment process.
