Published online Oct 18, 2017. doi: 10.5312/wjo.v8.i10.761
Peer-review started: December 2, 2016
First decision: February 17, 2017
Revised: June 20, 2017
Accepted: August 15, 2017
Article in press: August 16, 2017
Published online: October 18, 2017
Processing time: 322 Days and 9.9 Hours
To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement (TJR) in people who had undergone knee or hip replacement for osteoarthritis.
Participants (n = 1151) were recruited from Nottinghamshire post-total hip or knee replacement. Questionnaire assessment included medication use, the pain-DETECT questionnaire (PDQ) to assess neuropathic pain-like symptoms (NP) and TJR satisfaction measured on average 4.8 years post-TJR. Individual factors were tested for an association with post-TJR satisfaction, before incorporating all factors into a full model. Data reduction was carried out using LASSO and receiver operator characteristic (ROC) curve analysis was used to quantify the contribution of variables to post-TJR satisfaction.
After data reduction, the best fitting model for post-TJR satisfaction included various measures of pain, history of revision surgery, smoking, pre-surgical X-ray severity, WOMAC function scores and various comorbidities. ROC analysis of this model gave AUC = 0.83 (95%CI: 0.80-0.85). PDQ scores were found to capture much of the variation in post-TJR satisfaction outcomes: AUC = 0.79 (0.75-0.82). Pre-surgical radiographic severity was associated with higher post-TJR satisfaction: ORsatisfied = 2.06 (95%CI: 1.15-3.69), P = 0.015.
These results highlight the importance of pre-surgical radiographic severity, post-TJR function, analgesic medication use and NP in terms of post-TJR satisfaction. The PDQ appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction.
Core tip: The growing number of total joint replacement (TJR) surgeries performed worldwide every year means that research in this area has the potential to impact millions of people. These results highlight the importance of a number of factors with regards to post-TJR satisfaction. The pain-DETECT questionnaire for neuropathic pain-like symptoms (NP) appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction. Individuals with NP pre- or post-TJR could be indicated using this short questionnaire and referred for further testing and treatment to improve outcomes at every stage of their osteoarthritis treatment process.