Persistent Pain After Hip Replacement

November 28, 2023 updated by: Jens Laigaard, University Hospital Bispebjerg and Frederiksberg

Incidence of Persistent Pain After Total Hip Arthroplasty: A Nationwide Cross-sectional Survey Study

This study is a nationwide cross-sectional survey on pain and satisfaction after total hip arthroplasty (THA). Please find the full protocol uploaded on ClinicalTrials.gov

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

The study is registered at the Capitol region of Denmark's regional research listing (Pactius) with identifier P-2022-933, approved 23 December 2022. The resulting paper will be reported according to the CROSS checklist for standardised reporting of survey studies. Wherever needed, a trained linguist translated questions from English to Danish and vice versa. The Danish and an English version of the questionnaire will be available in the final publication.

  • Study design: This study is a nationwide cross-sectional survey.
  • Patient involvement: A panel of patients helped develop the questionnaire, i.e. testing and selecting the questions.
  • Questionnaire: The questionnaire is composed of 22 questions (please see the uploaded protocol), however patients answering "No" to question 3 skips questions 4-17 concerning pain in the operated hip. Only question 3, 4, 20, and 21 are mandatory as to avoid non-respondents. The full questionnaire translated to English can be found in the supplementary material in the protocol. Contact information for the first author (JL) is supplied in the contact letter in case the patients have difficulties with filling in the questionnaire, have questions, or believe they have been selected mistakenly. Similar or identical questions to those in a survey published in 2006 to increase the ability to compare results (i.e., questions 3-5, 8, 10 and 13)
  • Sample characteristics: Eligible patients are all adult (18 years or older) patients operated with primary THA for osteoarthritis between 1 March and May 31, 2022. Legally incompetent citizens, i.e., persons with a legal guardian, will not be asked to participate. Patients will be identified from the Danish National Patient Register through the Danish Health Data Authority (SKS-code DM16 [hip osteoarthritis] + KNFB [Primary Total Hip Arthroplasty]). Baseline data of respondents and non-respondents are gathered from the Danish Hip Arthroplasty Register. To evaluate the generalisability of the study, respondents' baseline data will be compared to the non-respondents baseline data in the paper's Table 1.
  • Sample size calculation: With an estimated 12% incidence of the primary outcome (patients with moderate or severe pain at rest and/or while walking) and a 70% response rate, 2577 patients are needed to yield a 95% confidence interval of 3 percentage points (10.5-13.5). This level of certainty is appropriate because differences less than this, may be hard to interpret by clinicians and patients. Sampling patients that were operated during 3 months outside holiday season should yield approximately this number of identified patients.
  • Ethical considerations: This study was approved by the local institutional review board and contact information are provided by the Danish Health Data Authority. Telephone numbers for non-respondents are found by searching the CPR number in the electronic patient files, but without accessing the patients' health data. According to Danish legislation, approval from the national ethics committee is neither required nor possible to obtain for survey studies (see attached 'exempt from notification' letter from the Danish national ethics committee).

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
2777

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

Study Locations

  • Denmark
      • Copenhagen, Denmark, 2200
        • Bispebjerg University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Patients are identifed from the Danish National Patient Register through the Danish Health Data Authority (SKS-code DM16 [hip osteoarthritis] + KNFB [Primary Total Hip Arthroplasty]). Baseline data of respondents and non-respondents are gathered from the Danish Hip Arthroplasty Register.

Description

Inclusion Criteria:

  • Patients operated with primary THA for osteoarthritis 12-15 months before survey distribution

Exclusion Criteria:

  • Legally incompetent citizens, i.e., persons with a legal guardian, will not be asked to participate.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Moderate/Severe persistent postsurgical pain
Time Frame: 12-15 months postoperatively
The main outcome is the number of patients with moderate or severe persistent postsurgical pain in the operated hip, defined as patients with a numerical rating scale (NRS) score higher than 3. The NRS score was dichotomised for the primary outcome because this is more intuitively understood by patients and clinicians. This outcome will be reported as percentage of all patients with 95% confidence interval, which is calculated with assumed binomial distribution as p ± 1.96 √( (p (1 - p) ) / n)
12-15 months postoperatively

Other Outcome Measures

Other Outcome Measures

For clinical trials, a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
How satisfied are you with the outcome of your hip replacement surgery? Very satisfied, Satisfied, Neither satisfied nor dissatisfied, Dissatisfied, Very dissatisfied
Time Frame: 12-15 months postoperatively
Reported as n (%) for each response option. The 1st question assesses overall satisfaction with surgery and have been translated directly from the questionnaire used by the Swedish Arthroplasty Register.
12-15 months postoperatively
Knowing what your hip replacement surgery did for you, if you could go back in time, would you still have undergone this surgery? Yes, No, Uncertain
Time Frame: 12-15 months postoperatively
Reported as n (%) for each response option.
12-15 months postoperatively
Pain frequency: Do you still have pain in the operated hip? Yes, constantly; Yes, daily; Yes, a few times a week; Ja, more rarely; No
Time Frame: 12-15 months postoperatively
Reported as n (%) for each response option.
12-15 months postoperatively
Numerical Rating Scale (NRS) pain: Please rate your pain in the operated hip by indicating the number that best describes your pain on average during the last week. 0 means 'No pain' and '10' means 'Pain as bad as you can imagine,'
Time Frame: 12-15 months postoperatively
Reported as median (interquartile range [IQR]) and number of respondents
12-15 months postoperatively
Pain domain of the likert-scale version 3.1 of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Time Frame: 12-15 months postoperatively
The five questions in the WOMAC pain domain can be scored 0-4, where 0 is 'none' and 4 is 'extreme'. This results in an overall score of 0-20, which will be reported as median (IQR). Moreover, each response option of the individual questions are reported as n (%).
12-15 months postoperatively
Pain interference: In total, how much does the pain in the operated hip bother you in your everyday life? Not at all, A little, Some, Much, Very Much
Time Frame: 12-15 months postoperatively
Reported as n (%) for each response option.
12-15 months postoperatively
Douleur Neuropathique 4 questions (DN4) interview
Time Frame: 12-15 months postoperatively
Each of the seven questions in the DN4 interview can be scored 0/1 (no/yes), which results in an overall score of 0-7. A score ≥3 constitutes 'possible' neuropathic pain. Both the median (IQR) DN4 interview score and number of patients (% of all patients) with possible neuropathic pain will be reported.
12-15 months postoperatively
Other pain: Do you have chronic pain, other than from your operated hip? Yes; No. [If yes] -> Please describe your pain condition:
Time Frame: 12-15 months postoperatively
Pain conditions will be categorised independently by two authors and reported as n (%).
12-15 months postoperatively
Analgesic use: Do you take analgesic medication(s) daily or almost daily? Yes; due to pain in the operated hip; Yes, due to other pain; No. [If yes] -> Which medication(s)?:
Time Frame: 12-15 months postoperatively
Reported as n (%).
12-15 months postoperatively
Height (cm)
Time Frame: 12-15 months postoperatively
12-15 months postoperatively
Weight (kg)
Time Frame: 12-15 months postoperatively
12-15 months postoperatively

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University Hospital Bispebjerg and Frederiksberg

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Study Director: Søren Overgaard, MD, PhD, Professor, Department of orthopedic surgery, Bispebjerg University Hospital, Denmark

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 4, 2023

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
November 1, 2023

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
November 1, 2023

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
April 6, 2023

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 2, 2023

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
May 6, 2023

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
November 29, 2023

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 28, 2023

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
November 1, 2023

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • P-2022-933

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The full dataset will be stored at the Danish national archive (www.rigsarkivet.dk) if possible

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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