# Preoperative Risk Factors for Persistent Pain After Total Hip Arthroplasty for Hip Osteoarthritis: The Influence of Neuropathic Pain, Central Sensitization, and Pain Catastrophizing

## TL;DR

This study finds that preoperative central sensitization and pain catastrophizing are risk factors for ongoing pain after hip replacement surgery.

## Contribution

The study is the first to simultaneously examine neuropathic pain, central sensitization, and pain catastrophizing as preoperative risk factors for persistent postoperative pain after THA.

## Key findings

- Central sensitization and pain catastrophizing were significantly more common in patients with persistent postoperative pain.
- Multivariate analysis confirmed central sensitization and pain catastrophizing as independent risk factors for persistent pain after THA.
- About 11.6% of patients experienced persistent pain 12 months after surgery.

## Abstract

Background

Approximately 10% of patients experience persistent pain after total hip arthroplasty (THA). Pain mechanisms, such as neuropathic pain, central sensitization, and pain rupture symptoms, have been reported to be associated with persistent postoperative pain. However, no studies have examined these mechanisms simultaneously. Therefore, in this study, we aimed to investigate the preoperative prevalence of neuropathic pain, central sensitization, and pain catastrophizing among patients with hip osteoarthritis (OA) and identify risk factors for persistent pain after THA, focusing on neuropathic pain, central sensitization, and pain catastrophizing.

Methods

In this retrospective study, 311 patients who underwent THA for hip OA were included. Preoperative neuropathic pain, central sensitization, and pain catastrophizing were evaluated using the pain-DETECT, Central Sensitization Inventory, and Pain Catastrophizing Scale, respectively. Persistent postoperative pain was defined as a Numerical Rating Scale score ≥3 at 12 months postoperatively. Persistent and non-persistent pain groups were compared using univariate and multivariate analyses.

Results

Preoperatively, neuropathic pain, central sensitization, and pain catastrophizing were present in 84 (27.0%), 74 (23.8%), and 183 (58.8%) of patients, respectively. In this study, 36 (11.6%) patients experienced persistent pain. The persistent pain group had a significantly higher prevalence of central sensitization and pain catastrophizing than the non-persistent pain group (P < 0.01). Multivariate analysis revealed central sensitization and pain catastrophizing as independent risk factors for persistent postoperative pain.

Conclusion

This study highlights the importance of preoperative assessment of central sensitization and pain catastrophizing in predicting persistent pain after THA for hip OA. Addressing these factors using targeted interventions may improve postoperative outcomes and patient satisfaction.