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PLoS One. 2020 Jan 8;15(1):e0222370. doi: 10.1371/journal.pone.0222370. eCollection 2020.

Prognostics for pain in osteoarthritis: Do clinical measures predict pain after total joint replacement?

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Departamento de Biomedicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Instituto de Investigação e Inovação em Saúde-i3S, Universidade do Porto, Porto, Portugal.
Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America.
Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America.
Shirley Ryan AbilityLab, Chicago, IL, United States of America.
Departamento de Medicina Física e de Reabilitação, Centro Hospitalar e Universitário de São João, Porto, Portugal.
Department of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America.


A significant proportion of osteoarthritis (OA) patients continue to experience moderate to severe pain after total joint replacement (TJR). Preoperative factors related to pain persistence are mainly studied using individual predictor variables and distinct pain outcomes, thus leading to a lack of consensus regarding the influence of preoperative parameters on post-TJR pain. In this prospective observational study, we evaluated knee and hip OA patients before, 3 and 6 months post-TJR searching for clinical predictors of pain persistence. We assessed multiple measures of quality, mood, affect, health and quality of life, together with radiographic evaluation and performance-based tasks, modeling four distinct pain outcomes. Multivariate regression models and network analysis were applied to pain related biopsychosocial measures and their changes with surgery. A total of 106 patients completed the study. Pre-surgical pain levels were not related to post-surgical residual pain. Although distinct pain scales were associated with different aspects of post-surgical pain, multi-factorial models did not reliably predict post-surgical pain in knee OA (across four distinct pain scales) and did not generalize to hip OA. However, network analysis showed significant changes in biopsychosocial-defined OA personality post-surgery, in both groups. Our results show that although tested clinical and biopsychosocial variables reorganize after TJR in OA, their presurgical values are not predictive of post-surgery pain. Derivation of prognostic markers for pain persistence after TJR will require more comprehensive understanding of underlying mechanisms.

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Conflict of interest statement

The authors have declared that no competing interests exist.

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