Keywords
Perioperative pain
Pain management
Summary of evidence
Submitted : 2025-08-05
Accepted : 2025-08-20
Published : 2025-09-04
Abstract
Objective: A methodical compendium of the best evidence on the management of pain in the Perioperative phase in patients undergoing total hip arthroplasty to offer evidence-based support for practice in the clinic. Methods: In the 6S pyramid model, we looked for guidelines, clinical decisions, expert consensus, evidence summaries, recommended practices, and systematic reviews of perioperative pain management in total hip arthroplasty patients in domestic and international guideline websites, websites of professional associations, and both English and Chinese data banks from December 16, 2014, to December 16, 2024, to obtain detailed statistics on perioperative patient pain monitoring and management in total hip joint arthroplasty patients, and to check the results of these results from the following sources. Literature quality assessment, evidence extraction, and summarization were done independently by 2 researchers. Literature quality assessment, evidence extraction, and summarization were done independently by 2 researchers. Results: A total of 20 papers were included, including 2 clinical decisions, 8 guidelines, 6 expert consensus, 3 Meta-analyses, and 1 randomized controlled trial. Forty pieces of evidence were summarized in six areas: preoperative preparation, principles of analgesic regimen development, choice of anesthesia, pharmacological analgesic modalities, nonpharmacological analgesic modalities, and post-discharge pain management. Conclusion: Perioperative pain management for THA patients is necessary, and healthcare professionals can refer to the summarized evidence to improve patients’ perioperative pain, increase their postoperative exercise compliance, and accelerate the postoperative recovery process.
References
Ferguson R, Palmer A, Taylor A, et al., 2018, Hip Replacement. Lancet (London, England), 392(10158): 1662–1671.
Wu Y, Zeng Y, Bao X, et al., 2018, Comparison of Mini-subvastus Approach Versus Medial Parapatellar Approach in Primary Total Knee Arthroplasty. International Journal of Surgery (London, England), 57: 15–21.
Bian Y, Cheng X, Chang X, et al., 2020, Preliminary Statistics and Analysis of the Volume of Artificial Hip and Knee Replacement Surgeries in China From 2011 to 2019. Chinese Journal of Orthopaedics, 40(21): 8.
Wu Y, Wang J, Zhang Y, et al., 2020, Comparison of the Efficacy of Total Hip Arthroplasty for Femoral Neck Fracture Between SuperPATH Approach and Moore Approach. China Drugs & Clinics, 20(2): 262–264.
Fu A, Zheng C, Wang A, et al., 2005, Effects of Pain on Vital Signs of Postoperative Trauma Orthopedic Patients. Journal of Nursing, 2005(20): 3–5.
Skolnick P, 2018, The Opioid Epidemic: Crisis and Solutions. Annual Review of Pharmacology and Toxicology, 58: 143–159.
Erlenwein J, Müller M, Falla D, et al., 2017, Clinical Relevance of Persistent Postoperative Pain After Total Hip Replacement – A Prospective Observational Cohort Study. Journal of Pain Research, 10: 2183–2193.
Shi Y, Zhu P, Jia J, et al., 2022, Cost-effectiveness of Same-day Discharge Surgery for Primary Total Hip Arthroplasty: A Pragmatic Randomized Controlled Study. Frontiers in Public Health, 10: 825727.
Shi M, Liu Y, Li H, et al., 2023, Summary of the Best Evidence for Physical Activity in Patients After Hip Arthroplasty. Journal of Nursing, 38(17): 116–120.
Qu C, Guo H, Wei Y, et al., 2021, Summary of the Best Evidence for Fatigue Management After Maintenance Hemodialysis. Journal of Nursing, 28(5): 6.
Wang A, Liu X, Zhou Y, 2024, Summary of the Best Evidence for Surgical Site Infection Prevention in Patients Undergoing Lumbar Spine Fusion. Nursing Research, 38(22): 4019–4025.
Foster M, Shurtz S, 2013, Making the Critical Appraisal for Summaries of Evidence (CASE) for Evidence-based Medicine (EBM): Critical Appraisal of Summaries of Evidence. Journal of the Medical Library Association (JMLA), 101(3): 192–198.
The Agree Reporting Checklist: A Tool to Improve Reporting of Clinical Practice Guidelines, 2016, BMJ (Clinical Research Ed.), 354: i4852.
Yuan S, Wang Y, Jia L, et al., 2023, Summary of Best Evidence for Yoga Exercise Management in Patients with Cancer-Caused Fatigue. Chinese Journal of Nursing, 58(1): 91–97.
The Joanna Briggs Institute (JBI), 2017, Checklist for Systematic Reviews, visited on January 5, 2023, https://jbi.global/critical-appraisal-tools
Higgins J, Altman D, Gøtzsche P, et al., 2011, The Cochrane Collaboration’s Tool for Assessing Risk of Bias in Randomised Trials. BMJ, 343: d5928.
Hasegawa M, Inoue Y, Kaneko S, et al., 2020, Wound, Pressure Ulcer and Burn Guidelines – 1: Guidelines for Wounds in General, Second Edition. The Journal of Dermatology, 47(8): 807–833.
Edward R, 2024, Approach to the Management of Acute Pain in Adults, visited on December 25, 2024, https://www.uptodate.com/contents/zh-Hans/approach-to-the-man agement-of-acute-pain-in-adults.
Kayser E, Linda L, Barys I, 2024, Anesthesia for Orthopedic Trauma, visited on December 25, 2024, https://www.uptodate.com/contents/zh-Hans/anesthesia-for-orthopedic-trauma.
National Institute for Health and Care Excellence (NICE), 2020, Joint Replacement (Primary): Hip, Knee and Shoulder, visited on December 25, 2024, https://www.nice.org.uk/terms-and-conditions#notice-of-rights
Hannon C, Fillingham Y, Mason J, et al., 2022, Corticosteroids in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. The Journal of Arthroplasty, 37(9): 1684–1687.
Anger M, Valovska T, Beloeil H, et al., 2021, PROSPECT Guideline for Total Hip Arthroplasty: A Systematic Review and Procedure-Specific Postoperative Pain Management Recommendations. Anaesthesia, 76(8): 1082–1097.
Fillingham Y, Hannon C, Erens G, et al., 2020, Acetaminophen in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. The Journal of Arthroplasty, 35(10): 2697–2699.
Hannon C, Fillingham Y, Nam D, et al., 2020, Opioids in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. The Journal of Arthroplasty, 35(10): 2709–2714.
Hannon C, Fillingham Y, Gililland J, et al., 2022, Ketamine in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. The Journal of Arthroplasty, 37(9): 1688–1690.
Fillingham Y, Hannon C, Roberts K, et al., 2020, Nonsteroidal Anti-Inflammatory Drugs in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. The Journal of Arthroplasty, 35(10): 2704–2708.
Hannon C, Fillingham Y, Spangehl M, et al., 2022, Periarticular Injection in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. The Journal of Arthroplasty, 37(9): 1701–1707.
Shen B, Weng X, Liao J, et al., 2016, Accelerated Rehabilitation of Hip and Knee Arthroplasty in China – Expert Consensus on Perioperative Pain and Sleep Management. Chinese Journal of Bone and Joint Surgery, 9(2): 91–97.
Zhou Z, Weng X, Qu T, et al., 2016, Accelerated Rehabilitation of Hip and Knee Arthroplasty in China – Expert Consensus on Perioperative Management Strategies. Bone and Joint Surgery China, 9(1): 1–9.
Chinese Association of Geriatric Health Care, Tong P, 2021, Expert Consensus on Accelerated Perioperative Rehabilitation for Hip and Knee Replacement. Journal of Practical Orthopaedics, 27(11): 961–965.
Yao X, 2017, Chinese Medicine Orthopedics and Traumatology Clinical Diagnosis and Treatment Guideline – Expert Consensus on Perioperative Rehabilitation of Artificial Hip Replacement. Journal of Rehabilitation, 27(4): 1–6.
Gao S, Xiong Y, 2024, Chinese Expert Consensus on Clinical Practice of Daytime Hip Arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 38(5): 513–520.
Arthroscopy Group of the Chinese Orthopaedic Association, 2023, Expert Consensus on Perioperative Management of Day Surgery for Hip and Knee Replacement in China. Chinese Electronic Journal of Geriatric Orthopedics and Rehabilitation, 9(6): 321–332.
Hu Z, Zhang Z, Tian X, 2023, Efficacy of Ultrasound-Guided Quadratus Lumborum Block for Postoperative Analgesia After Hip Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. The Journal of Arthroplasty, 38(1): 194–201.
Yang M, Ye C, Xing Y, et al., 2022, Meta-Analysis of Postoperative Regression of Hip Arthroplasty Patients by Transcutaneous Electrical Stimulation of Acupoints. China Medical Journal, 2022(15): 19.
Li M, Sun W, Zhou R, et al., 2022, Non-Pharmaceutical Treatments to Relieve Pain or Reduce Opioid Analgesic Intake and Improve Quality of Life After Total Hip Replacement: A Meta-Analysis. American Journal of Translational Research, 14(10): 6828–6845.
Steiness J, Hägi-Pedersen D, Lunn T, et al., 2024, Non-Opioid Analgesic Combinations Following Total Hip Arthroplasty (RECIPE): A Randomised, Placebo-Controlled, Blinded, Multicentre Trial. The Lancet Rheumatology, 6(4): e205–e215.
Stevenson K, Neuwirth A, Sheth N, 2018, Perioperative Pain Management Following Total Joint Arthroplasty: A Review and Update to an Institutional Pain Protocol. Journal of Clinical Orthopaedics and Trauma, 9(1): 40–45.
Chen Y, Niu D, Xin M, et al., 2024, Safety of Day Surgery for Total Joint Replacement. Chinese Journal of Bone and Joint Surgery, 17(11): 1024–1028.