Background/Purpose: Persistent pain and functional limitation are unfavorable outcomes after knee and hip replacement, which are getting increasing attention due to a dramatic increase in rates of knee and hip replacements. Our objective was to assess the association of ipsilateral knee/hip pain on short- and mid-term pain and function outcomes after total hip or knee arthroplasty (THA/TKA)

Methods:   We used the prospectively collected data from the Mayo Clinic Total Joint Registry to assess the association of ipsilateral knee or hip joint involvement with moderate-severe pain and moderate-severe functional limitation at 2- and 5-year follow-up after primary and revision THA and TKA using multivariable-adjusted logistic regression analyses.  Analyses were adjusted for patient characteristics (unmodifiable – age and gender; and modifiable – BMI, comorbidity, depression and anxiety), implant fixation (cemented/hybrid versus not cemented) and health care access as assessed by the distance from medical center.

Results:   At 2-year, 3,823 primary THA, 4,701 primary TKA, 1,218 revision THA and 725 revision TKA were studied.  After adjusting for multiple covariates, ipsilateral knee pain was significantly associated with outcomes after primary THA (all p-values <0.01): (1) moderate-severe pain: at 2-years, odds ratio (OR), 2.3 [95% confidence interval (CI), 1.5, 3.6]; at 5-years, OR 1.8 [95% CI:1.1, 2.7]; (2) moderate-severe functional limitation: at 2-years, OR 3.1 [95% CI:2.3, 4.3]; at 5-years, OR 3.6 [95% CI:2.6, 5.0].  Ipsilateral hip pain was significantly associated with outcomes after primary TKA (all p-values <0.01): (1) moderate-severe pain: at 2-years, OR 3.3 [95% CI:2.3, 4.7] ]; at 5-years, OR 1.8 [95% CI:1.1, 2.7]; (2) moderate-severe functional limitation: at 2-years, OR 3.6 [95% CI:2.6, 4.9]; at 5-years, OR 2.2 [95% CI:1.6, 3.2].  Similar associations were noted for revision THA and TKA patients.

Conclusion:   Presence of ipsilateral joint involvement after primary and revision THA and TKA is a poor prognostic factor for pain and function outcomes.  A potential way to improve outcomes may be to address ipsilateral lower extremity joint involvement.