# Biopsychosocial predictive factors for developing chronic postsurgical pain after hip replacement surgery: A systematic review

## TL;DR

This paper reviews factors that predict chronic pain after hip replacement surgery, aiming to improve patient outcomes through better risk identification.

## Contribution

The study systematically reviews recent literature to identify biopsychosocial factors predicting chronic postsurgical pain after hip replacement.

## Key findings

- Multiple biopsychosocial factors like BMI, preoperative pain, and anxiety are linked to chronic pain after hip surgery.
- Some factors like age and sex show associations, but results are mixed for others like comorbidities.
- Identified risk factors suggest opportunities for prehabilitation and personalized pain management strategies.

## Abstract

Total hip arthroplasty for end stage osteoarthritis is a common and often successful procedure. However, 14 ​% of patients experience chronic postsurgical pain after 1 year. The risk of developing chronic pain is multifactorial. The aim of this systematic review is to provide an overview of recent literature on predictive factors for developing postsurgical chronic pain after total hip arthroplasty to create a prognostic model for better recognition, perioperative optimization or reconsideration.

Studies were eligible if patients were over 18 years old, biopsychosocial risk factors and the occurrence of pain >3 months after surgery was reported. PubMed, EMBASE and CENTRAL were searched up to June 16th, 2025. The selected studies were screened and assessed on quality and risk of bias.

Fifteen studies met the inclusion criteria. These studies identified multiple biopsychosocial factors that may contribute to the development of chronic postsurgical pain. These include body mass index, preoperative (neuropathic) pain, the presence of comorbidities and functional disability, smoking, non-white race, sleep disturbances, depressive symptoms, anxiety, central sensitization, and pain catastrophizing. Additional associations were found for (younger) age and female sex. Some studies failed to demonstrate significant associations of certain factors, highlighting the complexity of chronic pain.

The identified, modifiable risk factors could be targets for prehabilitation and optimization. Personalized multimodal analgesia strategies might be more beneficial in high risk patients. Chronic postsurgical pain should be part of the informed consent and non-operative options could be considered in high risk patients.

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