Real-world therapeutic monitoring after elective total knee and hip arthroplasty: single-center prospective cohort study

Background. The condition of patients after orthopedic surgery requires therapeutic monitoring with correction of concomitant therapy. Aim: To study changes of the general condition of patients after elective total knee arthroplasty (TKA) and elective total hip arthroplasty (THA) over time through active therapeutic monitoring to optimize management. Materials and Methods. This prospective cohort single-center study included 782 patients with detailed medical history, information about concomitant diseases and drug therapy. The severity of pain was assessed on a 10-point scale before surgery and then 1 and 3 months after arthroplasty. Results. The study population included 271 males (34.7%) and 511 females (65.3%). 595 subjects (76.1%) had hypertension (grade 1 – 71 patients, grade 2 – 252 patients, grade 3 – 272 patients). At 1 month after surgery, 18 patients (2.3%) reported instable blood pressure (BP), 43 patients (5.5%) reported a persistent BP decrease requiring a reduction of antihypertensive drugs doses. Before surgery 604 patients (77.2%) were taking non-steroidal anti-inflammatory drugs (NSAIDs); at 1 month a significant ( p < 0.0001) decrease in the frequency of NSAIDs was noted – only 332 patients (42.4%) continued taking NSAIDs. At 1, 3 and 6 months after surgery, 17, 27 and 44 patients, respectively, reported an increase of pain severity in the joints of the intact extremity with an increase in the need for NSAIDs; about half of this subgroup also reported an increase in the number of episodes of elevated BP. Correlation analysis after surgery revealed a significant relationship between BP and the pain severity ( r = 0.731, p < 0.0001) and the frequency of taking NSAIDs ( r = 0.681, p = 0.01), as well as the patient’s activity and the severity of pain in the non-operated extremity ( r = 0.782, p < 0.0001). Conclusion. Patients undergoing elective TKA or THA have a high incidence of hypertension and often take NSAIDs. In the postoperative period, a statistically significant relationship between the severity of pain and NSAIDs use with BP levels, as well as a statistically significant relationship between activity and exacerbation of osteoarthritis of the joints of the non-operated extremity was found. This trend requires continued therapeutic monitoring in the postoperative period from 3 to 6 months for appropriate therapy correction.