Aims. The aim of this study was to determine whether total hip arthroplasty (THA) for chronic hip pain due to unilateral primary osteoarthritis (OA) has a beneficial effect on cognitive performance. Methods. A prospective cohort study was conducted with 101 patients with end-stage hip OA scheduled for THA (mean age 67.4 years (SD 9.5), 51.5% female (n = 52)). Patients were assessed at baseline as well as after three and months. Primary outcome was cognitive performance measured by d2 Test of Attention at six months, Trail Making Test (TMT), FAS-test, Rivermead Behavioural Memory Test (RBMT; story recall subtest), and Rey-Osterrieth Complex Figure Test (ROCF). The improvement of cognitive performance was analyzed using repeated measures analysis of variance. Results. At six months, there was significant improvement in attention, working speed and concentration (d2-test; p < 0.001), visual construction and visual memory (ROCF; p < 0.001), semantic memory (FAS-test; p = 0.009), verbal episodic memory (RBMT; immediate recall p = 0.023, delayed recall p = 0.026), as well as pain (p < 0.001) with small to large effect sizes. Attention, concentration, and visual as well as verbal episodic memory improved significantly with medium effect sizes over η. 2. partial. = 0.06. In these cognitive domains the within-group difference exceeded the minimum clinically important difference. Conclusion. THA is associated with clinically relevant postoperative improvement in the cognitive functions of attention, concentration, and memory. These data support the concept of a broad interaction of arthroplasty with
The patient with a painful arthritic knee awaiting
total knee arthroplasty (TKA) requires a multidisciplinary approach.
Optimal control of acute post-operative pain and the prevention
of chronic persistent pain remains a challenge. The aim of this
paper is to evaluate whether stratification of patients can help
identify those who are at particular risk for severe acute or chronic
pain. Intense acute post-operative pain, which is itself a risk factor
for chronic pain, is more common in younger, obese female patients
and those suffering from central pain sensitisation. Pre-operative
pain, in the knee or elsewhere in the body, predisposes to central
sensitisation. Pain due to osteoarthritis of the knee may also trigger
neuropathic pain and may be associated with chronic medication like
opioids, leading to a state of nociceptive sensitisation called
‘opioid-induced hyperalgesia’. Finally, genetic and personality
related risk factors may also put patients at a higher risk for
the development of chronic pain. Those identified as at risk for chronic pain would benefit from
specific peri-operative management including reduction in opioid
intake pre-operatively, the peri-operative use of antihyperalgesic
drugs such as ketamine and gabapentinoids, and a close post-operative
follow-up in a dedicated chronic pain clinic. Cite this article:
Total knee arthroplasty (TKA) is a major orthopaedic
intervention. The length of a patient's stay has been progressively
reduced with the introduction of enhanced recovery protocols: day-case
surgery has become the ultimate challenge. This narrative review shows the potential limitations of day-case
TKA. These constraints may be social, linked to patient’s comorbidities,
or due to surgery-related adverse events (e.g. pain, post-operative
nausea and vomiting, etc.). Using patient stratification, tailored surgical techniques and
multimodal opioid-sparing analgesia, day-case TKA might be achievable
in a limited group of patients. The younger, male patient without
comorbidities and with an excellent social network around him might
be a candidate. Demographic changes, effective recovery programmes and less invasive
surgical techniques such as unicondylar knee arthroplasty, may increase
the size of the group of potential day-case patients. The cost reduction achieved by day-case TKA needs to be balanced
against any increase in morbidity and mortality and the cost of
advanced follow-up at a distance with new technology. These factors
need to be evaluated before adopting this ultimate ‘fast-track’
approach. Cite this article:
