Why don't patients seek help for chronic post‐surgical pain after knee replacement? A qualitative investigation

Background: Although many people are satisfied with their outcome after total knee replacement surgery for osteoarthritis, around 20% report chronic post-surgical pain. People are often disappointed and unsure about whether their pain is normal and what can be done about it. Given the high prevalence of long-term postoperative pain after knee replacement, there is potentially a large hidden population with an unaddressed need for care.

Objective: In this study we focus on understanding why some people choose not to consult healthcare for chronic post-surgical pain after knee replacement.

Methods: Semi-structured interviews were conducted with people who had received total knee replacement at either of two National Health Service hospitals in the United Kingdom, and who had chronic post-surgical pain (n=34, age 55-93 years). Data were audio-recorded, transcribed and analysed thematically.

Results: We found an overall sense of futility amongst participants who believed that nothing further could be done for their ongoing pain. People’s perception of their pain was often discordant with that of surgeons and physicians. Other factors that contributed to decisions not to seek help included low expectations about effectiveness and the risks involved in further treatment, treatment burden, participants’ prioritisation of other health conditions, and views about of candidacy. Many accepted their ongoing pain.

Conclusion: Our study indicates why some people with chronic pain after knee replacement do not seek further healthcare. Understanding patients’ beliefs and expectations about chronic post-surgical pain can inform approaches that might enable people to seek help in the future.