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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
  1. Andrew David Beswick1,
  2. Vikki Wylde1,
  3. Rachael Gooberman-Hill1,
  4. Ashley Blom1,
  5. Paul Dieppe2
  1. 1School of Clinical Sciences, University of Bristol, Bristol, UK
  2. 2Clinical Education Research Group, Peninsula Medical School, Plymouth, UK
  1. Correspondence to Andrew David Beswick; andy.beswick{at}


Background Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes. However, some people experience long-term pain.

Objectives To review published studies in representative populations with total hip or knee replacement for the treatment of osteoarthritis reporting proportions of people by pain intensity.

Data sources MEDLINE and EMBASE databases searched to January 2011 with no language restrictions. Citations of key articles in ISI Web of Science and reference lists were checked.

Study eligibility criteria, participants and interventions Prospective studies of consecutive, unselected osteoarthritis patients representative of the primary total hip or knee replacement population, with intensities of patient-centred pain measured after 3 months to 5-year follow-up.

Study appraisal and synthesis methods Two authors screened titles and abstracts. Data extracted by one author were checked independently against original articles by a second. For each study, the authors summarised the proportions of people with different severities of pain in the operated joint.

Results Searches identified 1308 articles of which 115 reported patient-centred pain outcomes. Fourteen articles describing 17 cohorts (6 with hip and 11 with knee replacement) presented appropriate data on pain intensity. The proportion of people with an unfavourable long-term pain outcome in studies ranged from about 7% to 23% after hip and 10% to 34% after knee replacement. In the best quality studies, an unfavourable pain outcome was reported in 9% or more of patients after hip and about 20% of patients after knee replacement.

Limitations Other studies reported mean values of pain outcomes. These and routine clinical studies are potential sources of relevant data.

Conclusions and implications of key findings After hip and knee replacement, a significant proportion of people have painful joints. There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Beswick AD, Wylde V, Gooberman-Hill R, et al. 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 2012;2:e000435. doi:10.1136/bmjopen-2011-000435

  • Contributors PD conceived the review. All authors contributed to the design of the review. ADB identified and acquired reports of studies. ADB and PD checked studies for eligibility. ADB and VW extracted and checked data. ADB analysed and interpreted the data. ADB drafted the manuscript. All authors contributed to the final version of the manuscript. All authors contributed to revision of the manuscript. All authors approved the final version of the manuscript.

  • Funding This article outlines independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-0407-10070). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests No financial support or other benefits have been received by any of the authors that could create a potential conflict of interest with regard to the work.

  • Patient consent We only used grouped patient data reported in published studies.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data extracted from articles included in the review are available from author ADB.

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