Chronic Postoperative Pain After Joint Replacement

Kristian Kjær Petersen, PhD Lars Arendt-Nielsen, Dr Med Sci, PhD Center for Sensory-Motor Interaction Department of Health Science and Technology Aalborg University Aalborg, Denmark T otal joint arthroplasty (TJA) surgery is considered to be an effective intervention to improve function and reduce pain in conditions such as end-stage knee osteoarthritis (OA). In the United States alone, the number of total knee arthroplasty (TKA) procedures has increased from 31.2 per 100,000 person-years in the period 1971–1976 to 220.9 in the period 2005–2008, and from 50.2 in 1969–1972 to 145.5 in 2005–2008 for total hip arthroplasty (THA) procedures [26]. By 2030 the incidence of THA and TKA is predicted to increase by approximately 200% and 700%, respectively [15]. Prosthesisrelated outcomes such as radiographic appearance of the prosthesis, implant survival, or surgeon-assessed outcomes are highly successful after TJA, and while most patients experience pain relief after TJA, about 20% of TKA and 10% THA patients develop chronic postoperative pain. Understanding pain is complex, and a single preoperative measure cannot predict chronic postoperative pain. However, several preoperative factors can indicate if a patient is at high risk of developing chronic postoperative pain following TJA. This issue of Pain: Clinical Updates is intended as a scientific update to review recent evidence on pre-, peri-, and postoperative risk factors for the development of chronic postoperative pain following TJA, focusing on THA and TKA.