Neuropathic pain-like symptoms and pre-surgery radiographic severity contribute to patient satisfaction 4.8 years post-total joint replacement

Table 1 Descriptive statistics categorised by total joint replacement satisfaction status and their contribution to the risk of dissatisfaction post-total joint replacement

	Trait	Very satisfied (n = 861)	Not very satisfied (n = 227)	Dissatisfied (n = 63)	OR not very satisfied/dissatisfied (95%CI)1
Demographic and morphometric	Age ± SD (yr)	73.2 ± 8.6	73.0 ± 8.8	72.2 ± 9.1	1.00 (0.98-1.01)
	% female	57.4	56.8	47.6	0.85 (0.65-1.12)
	BMI ± SD (kg/m2)	29 ± 5.2	29.4 ± 5.1	30.7 ± 5.9	1.03 (1.00-1.06)a
Type of surgery	THR (n = 494)	407 (82.4%)	74 (15.0%)	13 (2.6%)	0.58 (0.44-0.77)e
	TKR (n = 591)	410 (69.4%)	136 (23.0%)	45 (7.6%)	2.02 (1.50-2.71)e
	THR + TKR (n = 66)	44 (66.7%)	17 (25.8%)	5 (7.6%)	1.63 (0.95-2.78)
	Years since most recent surgery	4.26	3.96	4.58	0.99 (0.96-1.03)
Pre-operative X-ray	Radiographically severe OA	92.10%	93.40%	96.50%	0.49 (0.27-0.87)a
History of surgery	Previous arthroscopic knee surgery3	20.00%	26.40%	34.90%	1.65 (1.21-2.25)c
	Revision surgery	5.70%	9.30%	14.30%	2.36 (1.44-3.86)e
Psychological	% depression	15.9	22.0	28.6	1.64 (1.17-2.30)c
	PCS score (0-52)	8.2	12.8	19.7	1.06 (1.05-1.08)e
	Top tertile of PCS2	20.80%	37.00%	55.60%	3.40 (2.52-4.59)e
Use of medication	% opioid	21.7	39.5	41.3	2.37 (1.77-3.18)e
	% OTC	49.0	64.5	61.9	1.33 (0.84-2.12)
	% NSAIDs	7.8	12.3	3.2	1.83 (1.38-2.42)e
	% other prescription analgesics	12.2	20.0	23.8	1.85 (1.29-2.66)e
Measures of pain	PDQ score (0-35)	4.8	10.1	14.3	1.15 (1.13-1.18)e
	Possible Neuropathic Pain (PDQ > 12)	10.00%	33.90%	57.10%	5.91 (4.22-8.29)e
	Likely Neuropathic Pain (PDQ ≥ 19)	6.50%	18.10%	34.90%	7.66 (4.80-12.22)e
	VAS (0-10)	3.1	5.8	7.0	1.35 (1.29-1.41)e
	HighVAS (> 5)	30.80%	61.20%	76.20%	6.47 (4.80-8.73)e
	WOMAC pain (0-20)	5.2	8.5	10.9	1.28 (1.23-1.33)e
	WOMAC stiffness (0-8)	2.9	4.1	4.4	1.62 (1.49-1.76)e
	WOMAC function (0-76)	25.7	38.0	47.8	1.07 (1.06-1.08)e
Comorbidities	% heart disease/angina	16.7	19.4	27.0	1.34 (0.95-1.89)
	% stroke	5.1	9.3	12.7	2.09 (1.26-3.44)c
	% hypertension	52.3	50.2	57.1	0.95 (0.72-1.25)
	% asthma/COPD	13.8	15.4	14.3	1.07 (0.73-1.57)
	% irritable bowel syndrome	10.2	14.5	11.1	1.44 (0.96-2.17)
	% diabetes	11.8	15.0	19.0	1.28 (0.86-1.90)
	% gout	7.5	11.9	11.1	1.50 (0.95-2.37)
	% osteoporosis	11.0	10.1	19.0	1.23 (0.80-1.88)
	% cancer	15.9	19.8	17.5	1.29 (0.91-1.83)
	% current smoker	6.5	11.0	14.3	1.93 (1.22-3.07)c

¹All ORs are adjusted for age, sex and BMI;

²Individuals in the top tertile of scores for the PCS questionnaire were classified as high catastrophizing;

³This classification includes any previous arthroscopic knee surgery.

^aP < 0.05,

^cP < 0.01,

^eP < 0.001. PCS: Pain Catastrophizing Scale; BMI: Body mass index.

Table 2 The best fitting and pain-DETECT questionnaire models showing the contribution of factors to post-total joint replacement, post-total hip replacement and post-total knee replacement satisfaction

	Full/best fitting model	pain-DETECT questionnaire scores
Total joint replacement satisfaction	2.207 + (-0.013∙PCS) + (0.189∙sex) + (-0.398∙TKR) + (0.016∙BMI) + (-0.027∙WOMAC function) + (-0.042∙WOMAC stiffness) + (-0.012∙past knee surgery) + (-0.056∙PDQ) + (-0.483∙highVAS) + (-0.380∙revision surgery) + (0.352∙severe pre-surgical radiographic OA) + (-0.066∙OTC) + (-0.113∙opioid) + (-0.010∙current smoker) + (-0.218∙stroke) + (0.051∙hypertension) + (0.062∙IBS) + (-0.055∙gout) + (-0.123∙depression)	2.796 + (-0.142∙PDQ) + (-0.015∙age) + (0.382∙sex) + (0.004∙BMI)
Total hip replacement satisfaction	2.985 + (0.014∙years since surgery) + (-0.018∙age) + (0.036∙BMI) + (-0.036∙WOMAC function) + (0.599∙past knee surgery) + (-0.018∙PDQ) + (-0.725∙high VAS) + (-0.723∙revision surgery) + (0.779∙severe pre-surgical radiographic OA) + (-0.248∙OTC) + (-0.119∙opioid) + (-0.429∙other medications for pain relief) + (-0.442∙current smoker) + (-0.014∙stroke) + (-0.514∙depression) + (-0.022∙cancer)	4.788 + (-0.121∙PDQ) + (-0.038∙age) + (0.036∙sex) + (0.008∙BMI)
Total knee replacement satisfaction	2.425 + (-0.018∙PCS) + (0.190∙sex) + (0.00045∙BMI) + (-0.015∙WOMAC function) + (-0.130∙WOMAC stiffness) + (-0.076∙PDQ) + (-0.313∙high VAS) + (0.009∙severe pre-surgical radiographic OA) + (-0.143∙stroke) + (0.072∙hypertension) + (0.334∙IBS) + (-0.120∙gout)	1.072 + (-0.146∙PDQ) + (0.003∙age) + (0.467∙sex) + (0.011∙BMI)