Cheng Hung-Yuan, Beswick Andrew David, Bertram Wendy, Siddiqui Mohammad Ammar, Gooberman-Hill Rachael, Whitehouse Michael R, Wylde Vikki
Bristol Medical School, University of Bristol, Bristol, UK.
NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
BMJ Open. 2025 May 21;15(5):e088975. doi: 10.1136/bmjopen-2024-088975.
To update our previous systematic review to synthesise latest data on the prevalence of long-term pain in patients who underwent total hip replacement (THR) or total knee replacement (TKR). We aim to describe the prevalence estimates and trends in this review.
Systematic review and meta-analysis.
Update searches were conducted in MEDLINE and Embase databases from 1 January 2011 to 17 February 2024. Citation tracking was used to identify additional studies.
We included prospective cohort studies reporting long-term pain after THR or TKR at 3, 6, 12 and 24 months postoperative.
Two reviewers independently identified studies as eligible. One reviewer conducted data extraction, checked by a second reviewer. The risk of bias assessment was performed using Hoy's checklist. Bayesian, random-effects meta-analysis was used to synthesise the results.
For TKR, 68 studies with 89 time points, including 598 498 patients, were included. Multivariate meta-analysis showed a general decrease in pain proportions over time: 21.9% (95% CrI 15.6% to 29.4%) at 3 months, 14.1% (10.9% to 17.9%) at 6 months, 12.6% (9.9% to 15.9%) at 12 months and 14.6% (9.5% to 22.4%) at 24 months. Considerable heterogeneity, unrelated to examined moderators, was indicated by substantial prediction intervals in the univariate models. Substantial loss to follow-up and risk of bias led to low confidence in the results. For THR, only 11 studies were included, so it was not possible to describe the trend. Univariate meta-analysis estimated 13.8% (8.5% to 20.1%) and 13.7% (4.8% to 31.0%) of patients experiencing long-term pain 6 and 12 months after THR, respectively, though concerns in risk of bias results reduced confidence in these findings.
Our review suggests that approximately 22% of patients report pain 3 months post-TKR, with 12%-15% experiencing long-term pain up to 2 years. At least 14% report pain 6-12 months after THR. Given the prevalence of chronic postsurgical pain, implementing existing and developing new preventive and management strategies is crucial for optimal patient outcomes.
CRD42023475498.
更新我们之前的系统评价，以综合全髋关节置换术（THR）或全膝关节置换术（TKR）患者长期疼痛患病率的最新数据。我们旨在描述本评价中的患病率估计值和趋势。
系统评价和荟萃分析。
于2011年1月1日至2024年2月17日在MEDLINE和Embase数据库中进行更新检索。采用引文追踪来识别其他研究。
我们纳入了前瞻性队列研究，这些研究报告了THR或TKR术后3、6、12和个月时的长期疼痛情况。
两名评价员独立确定符合条件的研究。一名评价员进行数据提取，由另一名评价员进行核对。使用霍伊清单进行偏倚风险评估。采用贝叶斯随机效应荟萃分析来综合结果。
对于TKR，纳入了68项研究，共89个时间点，包括598498例患者。多变量荟萃分析显示，随着时间推移，疼痛比例总体呈下降趋势：术后3个月为21.9%（95%CrI为15.6%至29.4%），6个月为14.1%（10.9%至17.9%），12个月为12.6%（9.9%至15.9%），24个月为14.6%（9.5%至22.4%）。单变量模型中较大的预测区间表明存在与所检查的调节因素无关的显著异质性。大量失访和偏倚风险导致对结果的信心较低。对于THR，仅纳入了11项研究，因此无法描述趋势。单变量荟萃分析估计，THR术后6个月和12个月分别有13.8%（8.5%至20.1%）和13.7%（4.8%至31.0%）的患者经历长期疼痛，不过对偏倚风险结果的担忧降低了对这些发现的信心。
我们的评价表明，约22%的TKR患者在术后3个月报告疼痛，12%至15%的患者在长达2年的时间内经历长期疼痛。至少14%的患者在THR术后6至12个月报告疼痛。鉴于术后慢性疼痛的患病率，实施现有和开发新的预防及管理策略对于实现最佳患者结局至关重要。
PROSPERO注册号：CRD42023475498。
