Predictors of pain and use of pain medications following primary Total Hip Arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years

Jasvinder A Singh, David Lewallen, Jasvinder A Singh, David Lewallen

Abstract

Background: Study pain and use of pain medications and their predictors after primary Total Hip Arthroplasty (THA).

Methods: We examined whether gender, age (reference, < = 60 yrs), body mass index (BMI; reference, <25 kg/m2)), comorbidity measured by Deyo-Charlson index (5-point increase), anxiety and depression predict moderate-severe hip pain and use of pain medications 2- and 5-years after primary THA. Multivariable logistic regression adjusted for these predictors and distance from medical center, operative diagnosis, American Society of Anesthesiologists (ASA) score and implant type.

Results: Moderate-severe pain was reported by 8.1% at 2-years and 10.8% at 5-years. Significant predictors of moderate-severe pain at 2-year follow-up were [Odds ratio (95% confidence interval)]: BMI 35-39.9, 1.8 (1.2,2.8); BMI > = 40, 1.7 (1.0,2.9); depression, 2.1 (1.4,3.0). Moderate-severe pain at 5-years was more common in patients with higher BMI: 25-29.9, 1.5 (1.1,2.1); 30-34.9, 1.8 (1.2,2.6); 35-39.9, 1.9 (1.2,3.1); and > = 40, 3.1 (1.7,5.7).Significant predictors of NSAID use were [Odds ratio (95% confidence interval)]: female gender at 2- and 5-years, 1.4 (1.1,1.7) and 1.4 (1.1,1.8); BMI 35-39.9 at 2-years, 1.9 (1.4, 2.6) and 30-34.9 at 2-years, 1.7 (1.2,2.4); and depression at 5-years, 1.8 (1.2,2.8).Significant predictors of opioid medication use were [Odds ratio (95% confidence interval)]: female gender at 2- and 5-years, 2.0 (1.1,3.0) and 2.4 (1.4,4.0); BMI 30-34.9 at 2-years, 2.0 (1.0,3.9); and depression at 2-years, 2.0 (1.1,3.7).

Conclusions: Higher BMI and depression impacted moderate-severe pain; and female gender, higher BMI and depression predicted use of pain medications at 2- and 5-years post-primary THA.

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