Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY.
Biostatistics Core, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2022 Aug;37(8S):S830-S835.e3. doi: 10.1016/j.arth.2022.02.011. Epub 2022 Feb 11.
Pain catastrophizing, anxiety, and depression are associated with poor outcomes after total hip (THA) and total knee (TKA) arthroplasty. The goal of this study is to determine the relationship between post-operative pain scores and opioid consumption; and the association among pre-operative measures of anxiety, depression, and pain catastrophizing and post-operative opioid consumption in patients undergoing THA and TKA.
This is a single-institution prospective cohort study of 243 opioid-naïve patients undergoing elective, primary THA (n = 123) or TKA (n = 120) for osteoarthritis. Pre-operatively, patients completed the PROMIS-29 (Patient-Reported Outcomes Measures Information System; physical function/anxiety/depression/fatigue/sleep disturbance/social activities/pain interference/pain intensity) and Pain Catastrophizing Scale. Post-operatively, patients completed a weekly survey for 12 weeks determining morphine-milligram-equivalent (MME) opioid consumption, opioid cessation, and visual analog scale pain scores. Multivariable regression models determined the association between pre-operative scores and post-operative opioid consumption.
Mean (±standard deviation) total opioid consumption and duration was 75.1 ± 112.0 MME and 1.7 ± 1.7 weeks in THA and 384.7 ± 473.3 MME and 4.3 ± 3.5 weeks in TKA. Visual analog scale pain scores (0-100) after opioid cessation were 28.0 ± 22.9 in THA and 30.7 ± 25.8 in TKA. Multivariable regression showed that each unit increase in PROMIS-29 fatigue T-score was associated with 8.4 hours longer opioid usage in THA (P = .008) and 15.1 hours longer in TKA (P = .036), as well as 12.7 MME additional opioids in TKA (P = .027). There were no significant associations with other PROMIS-29 domains or the Pain Catastrophizing Scale.
Opioid use duration is different for THA and TKA and may correlate with pain scores. Only pre-operative fatigue was associated with post-operative opioid consumption. These findings should inform THA and TKA post-operative pain management pathways.
疼痛灾难化、焦虑和抑郁与全髋关节置换术（THA）和全膝关节置换术（TKA）后的不良结局有关。本研究的目的是确定术后疼痛评分与阿片类药物使用量之间的关系；以及在接受 THA 和 TKA 的患者中，术前焦虑、抑郁和疼痛灾难化的测量值与术后阿片类药物使用量之间的相关性。
这是一项单机构前瞻性队列研究，纳入了 243 名接受择期初次 THA（n=123）或 TKA（n=120）治疗骨关节炎的阿片类药物初治患者。术前，患者完成了 PROMIS-29（患者报告的结果测量信息系统；身体功能/焦虑/抑郁/疲劳/睡眠障碍/社会活动/疼痛干扰/疼痛强度）和疼痛灾难化量表。术后，患者完成了为期 12 周的每周调查，以确定吗啡毫克当量（MME）阿片类药物使用量、阿片类药物停药和视觉模拟评分疼痛。多变量回归模型确定了术前评分与术后阿片类药物使用量之间的关系。
THA 组的总阿片类药物使用量和持续时间的平均值（±标准差）分别为 75.1±112.0 MME 和 1.7±1.7 周，TKA 组分别为 384.7±473.3 MME 和 4.3±3.5 周。THA 组阿片类药物停药后疼痛视觉模拟评分（0-100）为 28.0±22.9，TKA 组为 30.7±25.8。多变量回归显示，PROMIS-29 疲劳 T 评分每增加 1 个单位，THA 组的阿片类药物使用时间延长 8.4 小时（P=0.008），TKA 组延长 15.1 小时（P=0.036），TKA 组额外使用 12.7 MME 阿片类药物（P=0.027）。其他 PROMIS-29 领域或疼痛灾难化量表与术后阿片类药物使用量均无显著相关性。
THA 和 TKA 的阿片类药物使用时间不同，可能与疼痛评分相关。只有术前疲劳与术后阿片类药物使用量相关。这些发现应有助于制定 THA 和 TKA 术后疼痛管理途径。
