• Spencer S Liu, Asokumar Buvanendran, James P Rathmell, Mona Sawhney, James J Bae, Mario Moric, Stephen Perros, Ashley J Pope, Lazaros Poultsides, Craig J Della Valle, Naomi S Shin, Colin J L McCartney, Yan Ma, Mahendrakumar Shah, Monica J Wood, Smith C Manion, and Thomas P Sculco.
• Department of Anesthesiology, Hospital for Special Surgery and Weill Cornell Medical College, 535 East 70th St., New York, NY 10021, USA. anessl@yahoo.com
• Int Orthop. 2012 Nov 1;36(11):2261-7.

PurposeThe ability to identify and focus care to patients at higher risk of moderate to severe postoperative pain should improve analgesia and patient satisfaction, and may affect reimbursement. We undertook this multi-centre cross-sectional study to identify preoperative risk factors for moderate to severe pain after total hip (THR) and knee (TKR) replacement.MethodsA total of 897 patients were identified from electronic medical records. Preoperative information and anaesthetic technique was gained by retrospective chart review. The primary outcomes were moderate to severe pain (pain score ≥ 4/10) at rest and with activity on postoperative day one. Logistic regression was performed to identify predictors for moderate to severe pain.ResultsModerate to severe pain was reported by 20 % at rest and 33 % with activity. Predictors for pain at rest were female gender (OR 1.10 with 95 % CI 1.01-1.20), younger age (0.96, 0.94-0.99), increased BMI (1.02, 1.01-1.03), TKR vs. THR (3.21, 2.73-3.78), increased severity of preoperative pain at the surgical site (1.15, 1.03-1.30), preoperative use of opioids (1.63, 1.32-2.01), and general anaesthesia (8.51, 2.13-33.98). Predictors for pain with activity were TKR vs. THR (1.42, 1.28-1.57), increased severity of preoperative pain at the surgical site (1.11, 1.04-1.19), general anaesthesia (9.02, 3.68-22.07), preoperative use of anti-convulsants (1.78, 1.32-2.40) and anti-depressants (1.50, 1.08-2.80), and prior surgery at the surgical site (1.28, 1.05-1.57).ConclusionsOur findings provide clinical guidance for preoperative stratification of patients for more intensive management potentially including education, nursing staffing, and referral to specialised pain management.

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