Predictors of pain and use of pain medications following primary Total Hip Arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years

<p>Abstract</p> <p>Background</p> <p>Study pain and use of pain medications and their predictors after primary Total Hip Arthroplasty (THA).</p> <p>Methods</p> <p>We examined whether gender, age (reference, < = 60 yrs), body mass index (BMI; reference, <25 kg/m²)), comorbidity measured by Deyo-Charlson index (5-point increase), anxiety and depression predict moderate-severe hip pain and use of pain medications 2- and 5-years after primary THA. Multivariable logistic regression adjusted for these predictors and distance from medical center, operative diagnosis, American Society of Anesthesiologists (ASA) score and implant type.</p> <p>Results</p> <p>Moderate-severe pain was reported by 8.1% at 2-years and 10.8% at 5-years. Significant predictors of moderate-severe pain at 2-year follow-up were [Odds ratio (95% confidence interval)]: BMI 35-39.9, 1.8 (1.2,2.8); BMI > = 40, 1.7 (1.0,2.9); depression, 2.1 (1.4,3.0). Moderate-severe pain at 5-years was more common in patients with higher BMI: 25-29.9, 1.5 (1.1,2.1); 30-34.9, 1.8 (1.2,2.6); 35-39.9, 1.9 (1.2,3.1); and > = 40, 3.1 (1.7,5.7).</p> <p>Significant predictors of NSAID use were [Odds ratio (95% confidence interval)]: female gender at 2- and 5-years, 1.4 (1.1,1.7) and 1.4 (1.1,1.8); BMI 35-39.9 at 2-years, 1.9 (1.4, 2.6) and 30-34.9 at 2-years, 1.7 (1.2,2.4); and depression at 5-years, 1.8 (1.2,2.8).</p> <p>Significant predictors of opioid medication use were [Odds ratio (95% confidence interval)]: female gender at 2- and 5-years, 2.0 (1.1,3.0) and 2.4 (1.4,4.0); BMI 30-34.9 at 2-years, 2.0 (1.0,3.9); and depression at 2-years, 2.0 (1.1,3.7).</p> <p>Conclusions</p> <p>Higher BMI and depression impacted moderate-severe pain; and female gender, higher BMI and depression predicted use of pain medications at 2- and 5-years post-primary THA.</p

Patients with osteoarthritis and avascular necrosis have better functional outcomes and those with avascular necrosis worse pain outcomes compared to rheumatoid arthritis after primary hip arthroplasty: a cohort study

BACKGROUND: This study was conducted to assess whether patient-reported outcomes (PROs) differ by the underlying diagnosis (rheumatoid arthritis (RA)/inflammatory arthritis, osteoarthritis (OA), avascular necrosis of bone (AVN), other) in patients undergoing primary total hip arthroplasty (THA). METHODS: We used prospectively collected data to assess the association of diagnosis with index hip function and pain. Moderate-severe activity limitation and moderate-severe pain were assessed at two- and five-year follow-up after primary THA using multivariable-adjusted logistic regression analyses. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: There were 5,707 primary THAs at two-years and 3,289 at five-years, 51% were women and the mean age was 65 years. The underlying diagnosis was RA in 3%, OA in 87%, AVN in 7% and other in 3%. In multivariable-adjusted analyses, compared to RA, diagnoses of OA and AVN were significantly associated with lower odds of moderate-severe activities of daily living limitations with an OR (95% CI) of 0.5 (0.3 to 0.8) (P = 0.01) and 0.4 (0.2 to 0.8) (P = 0.01), respectively, at two-years, but not at five-years, 0.7 (0.4 to 1.4) (P = 0.36) and 0.9 (0.4 to 1.8) (P = 0.78), respectively. At two-years, neither OA nor AVN were significantly associated with higher odds of moderate-severe pain (1.6 (0.6 to 4.5) (P = 0.40) and 2.8 (0.9 to 8.5) (P =0 0.06)), respectively. At five-years, AVN was associated with higher odds of moderate-severe pain with OR 4.1 (1.2 to 14.1) (P = 0.02), but not OA, 2.1 (0.7 to 6.5) (P = 0.22). CONCLUSIONS: We found that patients with OA and AVN had better functional outcomes and those with AVN worse pain outcomes after primary THA, compared to patients with RA/inflammatory arthritis. Insights into mediators of these relationships are needed to better understand these associations

Minorities with lupus nephritis and medications: a study of facilitators to medication decision-making

Prioritized facilitators in AA2 (UAB, Birmingham, AA, 6 low SES, 1 high SES). This table provides a list of prioritized facilitators to help patients make decisions about treatment choices in African-American patients in nominal group 2. AA African-American, SES socioeconomic status, UAB University of Alabama at Birmingham (DOC 43 kb

Do outcomes reported in randomised controlled trials of joint replacement surgery fulfil the OMERACT 2.0 Filter? A review of the 2008 and 2013 literature.

Background It is not known, whether outcome reporting in trials of total joint arthroplasty in the recent years is adequate or not. Our objective was to assess whether outcomes reported in total joint replacement (TJR) trials fulfil the Outcome Measures in Rheumatology (OMERACT) Filter 2.0. Methods We systematically reviewed all TJR trials in adults, published in English in 2008 or 2013. Searches were conducted in the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Two authors independently applied the inclusion criteria for the studies, and any disagreement was resolved with a third review author. All outcome measures were abstracted using a pre-piloted standardised data extraction form and assessed for whether they mapped to one of the three OMERACT Filter 2.0 core areas: pathophysiological, life impact, and death. Results From 1635 trials identified, we included 70 trials (30 in 2008 and 40 in 2013) meeting the eligibility criteria. Twenty-two (31%) trials reported the three essential OMERACT core areas. Among the 27 hip replacement surgery trials and 39 knee replacement surgery trials included, 11 hip (41%) and nine knee (23%) trials reported all three essential OMERACT core areas. The most common outcome domains/measures were pain (20/27, 74%) and function (23/27, 85%) in hip trials and pain (26/39, 67%) and function (27/39, 69%) in knee trials. Results were similar for shoulder and hand joint replacement trials. Conclusions We identified significant gaps in the measurement of OMERACT core outcome areas in TJR trials, despite the majority reporting outcome domains of pain and function. An international consensus of key stakeholders is needed to develop a core domain set for reporting of TJR trials