The Impact of Preoperative Pain Severity on Clinical and Functional Outcomes after Total Hip Arthroplasty

Abstract

Introduction. Total hip arthroplasty (THA) is the most effective surgical method for the treatment of end-stage dysplastic coxarthrosis, aimed at pain relief and improvement of joint function and quality of life. However, the effect of preoperative pain severity on postoperative outcomes remains controversial. This study aims to evaluate the relationship between preoperative pain (assessed via the Visual Analog Scale – VAS) and clinical/functional outcomes after THA. Material and methods. This prospective study included 129 patients (135 hips) who underwent THA between 2018 and 2020. Patients were categorized into three groups based on preoperative VAS scores: Group I – severe pain (VAS 7–8, n=94), Group II – very severe pain (VAS 9, n=25), Group III – unbearable pain (VAS 10, n=16). Pre- and postoperative evaluations included VAS, WOMAC, Harris Hip Score (HHS), Merle d’Aubigne–Postel score, SF-36, goniometric ROM, limping, and leg length discrepancy. Statistical analyses included Wilcoxon, Kruskal–Wallis, Bonferroni, and chi-square tests. Results. All groups showed significant postoperative improvements (p<0.001), with the greatest changes in the severe pain group (Z ≈ ±8.4). The lowest improvements were observed in the unbearable pain group (Z ≈ ±3.2–3.8). The most marked changes were found in HHS and limping. A negative correlation between pain intensity and postoperative outcomes was identified. Discussion. Higher preoperative pain levels were associated with poorer postoperative clinical and functional recovery. Central sensitization, muscle contractures, and psychological comorbidities may reduce rehabilitation potential. The findings are consistent with several prior studies. Conclusion. Preoperative pain severity is a significant prognostic factor in THA outcomes. Patients with moderate pain show better recovery, while those with unbearable pain require enhanced rehabilitation and multidisciplinary management. Pain severity and its distribution should be evaluated during patient selection.