JOA - 2026-05-08 - Journal Article
Is it Really Less Painful to Undergo Total Hip Arthroplasty than Total Knee Arthroplasty?
Singh M, Scannell DE, McAnena AP, Harary J, Schilling PL, Moschetti WE
Topics
Key Takeaway
THA patients achieved a pain plateau at 58 days with a 0.9-point lower mean plateau VAS score than TKA patients, who plateaued at 77 days postoperatively.
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Summary
This study compared daily VAS pain trajectories from 30 days preoperatively to 90 days postoperatively in THA and TKA patients enrolled in a web-based home therapy program. THA patients started with higher preoperative pain (0.7-point difference, p<0.001), dropped 1.8 points more within the first postoperative week, and plateaued at 58 versus 77 days with a 0.9-point lower mean plateau score than TKA patients. Preoperative narcotics users in both cohorts plateaued earlier but carried a 1.1-point higher mean postoperative pain score regardless of procedure.
Key Limitation
Self-selected enrollment in a web-based home therapy program introduces participation bias, likely excluding patients with worse functional status or lower health literacy, which may systematically underestimate postoperative pain in both cohorts.
Original Abstract
BACKGROUND
Severe hip and knee osteoarthritis can produce major pain, pain-related disability, and functional limitations. While total hip (THA) and knee (TKA) arthroplasties can provide pain relief in these populations, an assessment and comparison of their postoperative course of improvement in pain scores is lacking.
METHODS
In this retrospective review, patients who underwent unilateral THA or TKA between November 2018 and December 2023 and used a web-based home therapy program were included. In total, 1,373 THA and 1,428 TKA patients were included. Daily Visual Analog Scale (VAS) pain scores (0 to 10) were followed from 30 days preoperatively to 90 days postoperatively across all patients. Mean pre- and post-operative plateaus in pain scores were compared across all cohorts using multivariate linear regression analyses. The THA patients had lower mean age, percent women, and mean body mass index (P < 0.05).
RESULTS
Preoperatively, THA patients reported a 0.7 point higher mean pain score (P < 0.001). Within one week of surgery, THA patients noted a 1.8 points larger drop in pain scores. Postoperatively, THA patients noted an earlier drop (within the first versus within the second week) and plateau (58 versus 77 days) in pain scores and had a 0.9 point lower mean plateau pain score (P < 0.001) than TKA patients. After stratification by history of narcotics use, THA and TKA patients who reported preoperative narcotics use had a 0.6 point and 0.4 point higher mean preoperative pain score, respectively (P < 0.001). These patients achieved an earlier plateau in pain scores across both cohorts (THA: 53 versus 58 days;
TKA
54 versus 78 days), but had a 1.1 and 1.1 point higher mean postoperative pain score, respectively (P < 0.001).
CONCLUSION
While THA patients had more severe pain preoperatively, they experienced more immediate improvements in their pain outcomes, achieved an earlier plateau in their scores, and had lower postoperative pain than TKA patients. Preoperative narcotics use significantly worsened the postoperative course for both cohorts.