Clinical study

Perioperative Interventions for Reduction of Persistent Pain after Total Hip and Knee Arthroplasty

Pain from osteoarthritis is disabling and impairs life quality. Therefore, millions of patients are operated with primary total hip or knee arthroplasty each year. The proportion of patients that experience persistent pain after these surgeries is largely unknown, though it is essential for clinician and patient decision-making. The aetiology of persistent pain is believed to be central sensitisation because acute pain is closely linked to persistent postsurgical pain. Therefore, perioperative analgesia should decrease the risk of persistent postsurgical pain and long-term analgesic dependency. In our opinion, glucocorticoids deserve particular attention due to the combined anti-inflammatory and analgesic effect. We are in a unique position to investigate this area, e.g. with data linkage of high-quality Danish registries.

We aim to describe and reduce persistent pain after total hip and knee arthroplasty in the population as a whole and in individual patients.

The project is planned to comprise the following main studies.

I) Perioperative prevention of persistent pain after total hip and knee arthroplasty: A systematic review. This comprehensive review of the literature will create an overview of the current evidence.

II) Persistent postsurgical pain after total hip/knee arthroplasty: Nationwide cross-sectional survey studies. The knowledge on satisfaction and incidence of persistent postsurgical pain after total joint arthroplasties in Denmark is outdated. In addition to directly reporting the survey responses, we will investigate the impact of body weight, and validate the use of prescription data as a proxy marker for persistent postsurgical pain.

III) Effect of perioperative glucocorticoids on persistent opioid use after primary total knee and hip arthroplasty: An emulated stepped wedge cluster-randomised trial. Since 2010, Danish orthopaedic departments have been introducing glucocorticoids in a stepwise manner. This provides an opportunity to examine the effect of a single high-dose of intraoperative glucocorticoids on the risk for persistent opioid use, while also accounting for concomitant changes in clinical practice.

Because so many osteoarthritis patients undergo surgery each year, and because chronic pain is a large personal and societal burden, any reduction in the incidence of persistent postsurgical pain will have large impact. Moreover, the survey results will be utilised by patients and clinicians in decision making.

The project is scheduled from 1 September 2022 to 31 December 2025.