Pre-Existing Anxiety on Risk of Chronic Pain Development Following Total Hip Arthroplasty

Background: Total hip arthroplasty (THA) reliably improves pain and function in patients with advanced osteoarthritis; however, 7-23% develop chronic postsurgical pain (CPSP).Psychological factors, particularly anxiety, have been implicated in poorer postoperative outcomes, but their long-term impact on chronic pain after THA remains incompletely defined.Methods: Using the TriNetX analytics network, we conducted a retrospective cohort study of adults undergoing THA.Patients with (Cohort 2) and without (Cohort 1) a documented preoperative anxiety disorder were identified, excluding those with prior chronic pain diagnoses.Propensity score matching (1:1) was performed based on demographics, opioid analgesics, and relevant comorbidities.Logistic regression and Cox proportional hazards models evaluated the association between anxiety and development of chronic pain syndrome at 1, 3, and 5 years postoperatively.Results: After matching, each cohort included 8,097 patients with well-balanced demographic and clinical characteristics.Absence of preoperative anxiety was consistently associated with significantly lower risk of chronic pain at all time points.Compared with anxious patients, non-anxious patients demonstrated reduced odds of chronic pain at 1 year (OR 0.665, 95% CI 0.449, 0.984), 3 years (OR 0.639; 95% CI 0.460, 0.887), and 5 years (OR 0.734; 95% CI 0.543, 0.987).Hazard ratios showed similar protective associations.Conclusions: Pre-existing anxiety is independently associated with increased long-term risk of chronic pain following THA.These findings suggest that targeted perioperative management of anxiety may improve long-term postoperative outcomes.