Inter-individual differences in early post-operative pain, cognitions, and emotions after total hip arthroplasty: A longitudinal cohort study

Abstract

Objective To identify (1) pre- to early post-operative changes in pain and related cognitions and emotions, (2) early post-operative pain trajectories and their covariates, and (3) predictors of early post-operative cognitions and emotions. Design Longitudinal cohort study. Setting Secondary care setting at Hospital East-Limburg and the European Hip Center (Belgium). Participants One hundred thirty-three individuals with hip osteoarthritis undergoing total hip arthroplasty. Intervention Data were collected before total hip arthroplasty and during the first post-operative week. Main measures Sociodemographic information, traumatic experiences, anxiety, depression, perceived injustice, fear-avoidance, self-efficacy, and pain-related variables were assessed. Statistical analyses included Friedman tests to evaluate pre- to post-operative changes in pain and related cognitions and emotions, Latent Class Growth Analysis and multinomial logistic regression to identify pain trajectories and their covariates, and Least Absolute Shrinkage and Selection Operator regression to identify predictors of early post-operative cognitions and emotions. Results Four early post-operative pain trajectories were identified. Two trajectories (36%, n = 48) demonstrated no reduction in pain intensity one week after surgery. Higher levels of self-efficacy (odds ratio = 0.83) and pre- to post-operative reductions in perceived injustice (odds ratio = 0.86) were associated with lower odds of being classified in the unremitting pain trajectory. Between 38% and 64% in the variance of early post-operative cognitions and emotions could be predicted. Pre-operative perceived injustice showed a positive association with fear-avoidance (ss = 1.96) and anxiety symptoms (ss = 0.80). Conclusions Inter-individual differences exist in early post-operative pain after total hip arthroplasty but are poorly associated with cognitions or emotions. Pre-operative perceived injustice may influence early post-operative cognitions and emotions. Registration: ClinicalTrials.gov, NCT05265858 (https://classic.clinicaltrials.gov/ct2/show/NCT05265858)