Predictors of Long-Term Pain After Hip Arthroplasty in Patients With Femoral Neck Fractures: A Cohort Study.

Abstract

OBJECTIVES:

To identify factors associated with the development of prolonged pain after hip fracture surgery.

DESIGN:

Secondary analysis of a randomized controlled trial.

SETTING:

Eighty hospitals in 10 countries.

PATIENTS/PARTICIPANTS:

One thousand four hundred forty-one hip fracture patients in the HEALTH trial.

INTERVENTIONS:

Total hip arthroplasty or hemiarthroplasty.

MAIN OUTCOME MEASURES:

Moderate-to-severe pain (at least 2 activities on the Western Ontario and McMaster Universities Osteoarthritis questionnaire pain subscale with scores ≥2) at 12 and 24 months after hip arthroplasty.

RESULTS:

Of 840 and 726 patients with complete baseline data and outcomes at 1-year and 2-year follow-up, 96 (11.4%) and 80 (11.0%) reported moderate-to-severe pain, respectively. An increased risk of pain at both 1 and 2 years after surgery was associated with reporting moderate-to-severe hip pain before fracture [absolute risk increase (ARI) 15.3%, 95% confidence interval (CI) 6.44%-24.35%; ARI 12.5%, 95% CI 2.85%-22.12%, respectively] and prefracture opioid use (ARI 15.6%, 95% CI 5.41%-25.89%; ARI 21.1%; 95% CI 8.23%-34.02%, respectively). Female sex was associated with an increased risk of persistent pain at 1 year (ARI 6.2%, 95% CI 3.53%-8.84%). A greater risk of persistent pain at 2 years was associated with younger age (≤79-year-old; ARI 6.3%; 95% CI 2.67%-9.91%) and higher prefacture functional status (ARI 10.7%; 95% CI 3.80%-17.64%).

CONCLUSIONS:

Among hip fracture patients undergoing arthroplasty, approximately one in 10 will experience moderate-to-severe pain up to 2 years after surgery. Younger age, female sex, higher functioning prefracture, living with hip pain prefracture, and use of prescription opioids were predictive of persistent pain.

LEVEL OF EVIDENCE:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

• Authors: Atefeh Noori, Sheila Sprague, Sofia Bzovsky, Emil H Schemitsch, Rudolf W Poolman, Frede Frihagen, Daniel Axelrod, Diane Heels-Ansdell, Mohit Bhandari, Jason W Busse, HEALTH Investigators
• Journal: Journal of orthopaedic trauma (J Orthop Trauma) Vol. 34 Suppl 3 Pg. S55-S63 (11 2020) ISSN: 1531-2291 [Electronic] United States
• PMID: 33027167 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Aged
• Arthroplasty, Replacement, Hip (adverse effects)
• Cohort Studies
• Female
• Femoral Neck Fractures (complications, epidemiology, surgery)
• Humans
• Ontario
• Pain
• Treatment Outcome