Association between epidemiological factors and non-responders to total joint replacement surgery in primary osteoarthritis patients

Abstract Background While total joint replacement (TJR) is the most effective treatment for end stage osteoarthritis (OA), one third of patients do not experience clinically important improvement in pain or function following the surgery. Thus, it is important to identify factors for non-responders and develop strategies to improve TJR outcomes. Methods Study participants were patients who underwent TJR (hip/knee) due to OA and completed the WOMAC before and on average four years post-surgery. Non-responders (pain non-responders, function non-responders, pain and function non-responders) were determined using the WOMAC change score from baseline to follow-up under two previously reported criteria. Eighty-eight self-reported factors collected by a general health questionnaire were examined for associations with non-responders. Results A total of 601 patients (30.8% hip and 69.2% knee replacement) were included. 18% of them were found to be either pain or function non-responders. Nine factors were identified in the univariable analyses to be associated with non-responders, five (clinical depression, multisite musculoskeletal pain (MSMP), younger age, golfer’s elbow, and driving more than four hours on average per working day) of them remained significant in the multivariable analyses in at least one of six categories. Clinical depression, having MSMP, and younger age were the major factors to be independently associated with non-responders across five categories. In addition, two factors (age at menopause and age at hysterectomy) were significantly associated with female non-responders. Conclusion Our data suggested potential roles of pain perception, widespread pain sensitization, patient expectations, and early menopause in females in TJR outcomes, warranting further investigation.