Skip to main content

Advertisement

Log in

Personality traits predict residual pain after total hip and knee arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Aim of the study

We assessed the role of personality traits, anxiety, and depression in residual pain among patients who underwent total hip (THA) and knee (TKA) arthroplasty.

Method

Eighty-three patients (40 THA and 43 TKA) were interviewed pre-operatively (t0); five days (t1) after surgery; and one (t2), three (t3), six (t4), and 12 months (t5) after surgery. Personality (TCI-R), pain (VAS), anxiety and depression (HADS), quality of life (SF-12), functionality (HHS/KSS), and disability (WOMAC) were evaluated.

Results

Pain reduction and functional improvement were reported at t5 (both p < 0.001) in both THA and TKA patients. THA patients showed earlier and greater functional improvement after surgery (both p < 0.001) in comparison with TKA. Residual pain (VAS > 30 mm) was noted in 15% of the THA patients and 25% of the TKA patients, and it correlated with the SF-12 PCS (r2 = − 0.412; p < 0.001), SF-12 MCS (r2 = − 0.473; p < 0.001), HADS-A (r2 = 0.619; p = <0.001), HADS-D (r2 = 0.559; p < 0.001), functionality (r2 = − 0.482; p < 0.001), and WOMAC (r2 = 0.536; p < 0.001) scores at t5. High pre-operative harm avoidance, persistence, and anxiety scores were predictive of residual pain after both THA and TKA (p < 0.001).

Discussion

The proportion of patients complaining of residual pain in this study was similar to that in previous findings. Multiple predictors of residual pain after THA and TKA have been previously described, and several studies evaluated the influence of psychological factors on the outcome of joint arthroplasty; however, only four studies investigated the role of personality traits in the outcome of THA and TKA patients, and a unique study out of these investigations demonstrated the effect of personality on persisting pain.

Conclusion

The current study demonstrated that personality traits and anxiety predict residual pain; thus, pre-operative evaluation of these factors could be helpful in identifying patients at risk for residual pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hofmann S, Seitlinger G, Djahani O, Pietsch M (2011) The painful knee after TKA: a diagnostic algorithm for failure analysis. Knee Surg Sports Traumatol Arthrosc 19:1442–1452. https://doi.org/10.1007/s00167-011-1634-6

    Article  CAS  PubMed  Google Scholar 

  2. Izumi M, Petersen KK, Laursen MB et al (2017) Facilitated temporal summation of pain correlates with clinical pain intensity after hip arthroplasty. Pain 158:323–332. https://doi.org/10.1097/j.pain.0000000000000764

    Article  PubMed  Google Scholar 

  3. Conrad R, Schilling G, Bausch C et al (2007) Temperament and character personality profiles and personality disorders in chronic pain patients. Pain 133:197–209. https://doi.org/10.1016/j.pain.2007.07.024

    Article  PubMed  Google Scholar 

  4. Fossati A, Cloninger CR, Villa D et al (2007) Reliability and validity of the Italian version of the temperament and character inventory-revised in an outpatient sample. Compr Psychiatry 48:380–387

    Article  Google Scholar 

  5. Sorel JC, Veltman ES, Honig A, Poolman RW (2019) The influence of preoperative psychological distress on pain and function after total knee arthroplasty: a systematic review and meta-analysis. Bone Joint J 101-B:7–14. https://doi.org/10.1302/0301-620X.101B1.BJJ-2018-0672.R1

    Article  CAS  PubMed  Google Scholar 

  6. Vogel M, Riediger C, Krippl M et al (2019) Negative affect, type D personality, quality of life, and dysfunctional outcomes of total knee arthroplasty. Pain Res Manag 2019:1–9. https://doi.org/10.1155/2019/6393101

    Article  Google Scholar 

  7. Duivenvoorden T, Vissers MM, Verhaar JAN et al (2013) Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthr Cartil 21:1834–1840. https://doi.org/10.1016/j.joca.2013.08.022

    Article  CAS  PubMed  Google Scholar 

  8. Zhai H, Geng H, Bai B, Wang Y (2019) Differences in 1-year outcome after primary total hip and knee arthroplasty : a cohort study in older patients with osteoarthritis. Orthopade 48:136–143. https://doi.org/10.1007/s00132-018-3636-2

    Article  PubMed  Google Scholar 

  9. Erlenwein J, Müller M, Falla D et al (2017) Clinical relevance of persistent postoperative pain after total hip replacement &ndash; a prospective observational cohort study. J Pain Res 10:2183–2193. https://doi.org/10.2147/JPR.S137892

    Article  PubMed  PubMed Central  Google Scholar 

  10. van der Wees PJ, Wammes JJ, Akkermans RP et al (2017) Patient-reported health outcomes after total hip and knee surgery in a Dutch University Hospital Setting: results of twenty years clinical registry. BMC Musculoskelet Disord 18:97. https://doi.org/10.1186/s12891-017-1455-y

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lindner M, Nosseir O, Keller-Pliessnig A et al (2018) Psychosocial predictors for outcome after total joint arthroplasty: a prospective comparison of hip and knee arthroplasty. BMC Musculoskelet Disord 19:159. https://doi.org/10.1186/s12891-018-2058-y

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hamilton D, Henderson GR, Gaston P et al (2012) Comparative outcomes of total hip and knee arthroplasty: a prospective cohort study. Postgrad Med J 88:627–631. https://doi.org/10.1136/postgradmedj-2011-130715

    Article  PubMed  Google Scholar 

  13. Liebensteiner M, Wurm A, Gamper D, Oberaigner W, Dammerer D, Krismer M (2019) Patient satisfaction after total knee arthroplasty is better in patients with pre-operative complete joint space collapse. Int Orthop 43:1841–1847. https://doi.org/10.1007/s00264-018-4185-3

    Article  PubMed  Google Scholar 

  14. Ethgen O, Bruyère O, Richy F et al (2004) Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 86:963–974. https://doi.org/10.2106/00004623-200405000-00012

    Article  PubMed  Google Scholar 

  15. Beswick AD, Wylde V, Gooberman-Hill R et al (2012) What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2:e000435. https://doi.org/10.1136/bmjopen-2011-000435

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hassett AL, Marshall E, Bailey AM et al (2018) Changes in anxiety and depression are mediated by changes in pain severity in patients undergoing lower-extremity total joint arthroplasty. Reg Anesth Pain Med 43:14–18. https://doi.org/10.1097/AAP.0000000000000682

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ramaesh R, Jenkins P, Macdonald D et al (2014) Personality, function and satisfaction in patients undergoing total hip or knee replacement. J Orthop Sci 19:275–281. https://doi.org/10.1007/s00776-013-0509-8

    Article  PubMed  Google Scholar 

  18. Benditz A, Jansen P, Schaible J et al (2017) Psychological factors as risk factors for poor hip function after total hip arthroplasty. Ther Clin Risk Manag 13:237–244. https://doi.org/10.2147/TCRM.S127868

    Article  PubMed  PubMed Central  Google Scholar 

  19. Badura-Brzoza K, Zajac P, Brzoza Z et al (2009) Psychological and psychiatric factors related to health-related quality of life after total hip replacement - preliminary report. Eur Psychiatry 24:119–124. https://doi.org/10.1016/j.eurpsy.2008.06.009

    Article  PubMed  Google Scholar 

  20. Gustin SM, Burke LA, Peck CC et al (2016) Pain and personality: do individuals with different forms of chronic pain exhibit a mutual personality? Pain Pract 16:486–494. https://doi.org/10.1111/papr.12297

    Article  PubMed  Google Scholar 

  21. Naylor B, Boag S, Gustin SM (2017) New evidence for a pain personality? A critical review of the last 120 years of pain and personality. Scand J Pain 17:58–67. https://doi.org/10.1016/j.sjpain.2017.07.011

    Article  PubMed  Google Scholar 

  22. Nahman-Averbuch H, Yarnitsky D, Sprecher E et al (2016) Relationship between personality traits and endogenous analgesia: the role of harm avoidance. Pain Pract 16:38–45. https://doi.org/10.1111/papr.12256

    Article  PubMed  Google Scholar 

  23. Burns LC, Ritvo SE, Ferguson MK et al (2015) Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review. J Pain Res 8:21–32. https://doi.org/10.2147/JPR.S64730

    Article  PubMed  PubMed Central  Google Scholar 

  24. Vlaeyen JW, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332

    Article  CAS  Google Scholar 

  25. Halvorsen M, Wang CE, Richter J et al Early maladaptive schemas, temperament and character traits in clinically depressed and previously depressed subjects. Clin Psychol Psychother 16:394–407. https://doi.org/10.1002/cpp.618

  26. Desmeules F, Dionne CE, Belzile ÉL et al (2013) Determinants of pain, functional limitations and health-related quality of life six months after total knee arthroplasty: results from a prospective cohort study. BMC Sports Sci Med Rehabil 5:2. https://doi.org/10.1186/2052-1847-5-2

    Article  PubMed  PubMed Central  Google Scholar 

  27. Núñez-Cortés R, Chamorro C, Ortega-Palavecinos M, Mattar G, Paredes O, Besoaín-Saldaña Á, Cruz-Montecinos C (2019) Social determinants associated to chronic pain after total knee arthroplasty. Int Orthop 43:2767–2771. https://doi.org/10.1007/s00264-019-04370-6

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Michele Mercurio, Cristina Segura-Garcia, and Giorgio Gasparini. The first draft of the manuscript was written by Michele Mercurio, Cristina Segura-Garcia, Giorgio Gasparini, and Olimpio Galasso, and all authors commented on previous versions of the manuscript. Elvira Anna Carbone aided in interpreting the results and worked on the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Giorgio Gasparini.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Mater Domini Ethics committee n. 14/2015) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.”

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mercurio, M., Gasparini, G., Carbone, E.A. et al. Personality traits predict residual pain after total hip and knee arthroplasty. International Orthopaedics (SICOT) 44, 1263–1270 (2020). https://doi.org/10.1007/s00264-020-04553-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04553-6

Keywords

Navigation