Association between intraoperative noise intensity during hip arthroplasty and the postoperative risk of kinesiophobia: a prospective cohort study.

OBJECTIVE: The study aimed to investigate the association between intraoperative noise during hip arthroplasty and the development of postoperative kinesiophobia, as well as the predictive value of intraoperative noise for postoperative kinesiophobia, and associations of intraoperative noise with short-term postoperative pain, anxiety, and early functional recovery. METHODS: This prospective cohort study enrolled patients undergoing unilateral primary total hip arthroplasty under spinal anesthesia. Patients were divided into a high-noise group (> 70 dB) and a low-noise group (≤ 70 dB) according to the level of intraoperative ambient noise. The primary outcome was the Tampa Scale of Kinesiophobia (TSK-17) score on the third postoperative day. Secondary outcomes included Visual Analog Scale (VAS) scores (days 1 and 3), Hospital Anxiety and Depression Scale (HADS) scores (day 1), and Harris Hip Score (HHS) (day 3). The association between noise level and TSK score was assessed using Spearman correlations, while multivariate logistic regression evaluated intraoperative noise as a predictor of Kinesiophobia, and independent associations between other postoperative variables and Kinesiophobia were investigated. The discriminative accuracy of intraoperative noise for predicting Kinesiophobia was examined using receiver operating characteristic (ROC) curves. RESULTS: TSK scores were significantly higher in the high-noise group than in the low-noise group (43.2 ± 5.6 vs. 35.8 ± 5.0, P < 0.001). VAS scores were also significantly higher on postoperative day 1 (5.4 ± 1.3 vs. 4.0 ± 1.1) and day 3 (5.1 ± 1.2 vs. 3.6 ± 1.0; both P < 0.001). HADS scores were higher (10.8 ± 3.0 vs. 8.9 ± 2.4, P < 0.001) in the high-noise group, while HHS scores were lower (69.5 ± 7.4 vs. 76.2 ± 6.8, P < 0.001). Intraoperative noise level correlated positively with the TSK score (r = 0.600, P < 0.001) and was also independently predictive of postoperative kinesiophobia (OR=1.18, 95% CI: 1.09-1.29, P < 0.001). ROC curves showed intraoperative noise predicted kinesiophobia with an AUC = 0.814; optimal cutoff = 72.3 dB (sensitivity = 82.1%, specificity = 75.4%). Lastly, VAS and HADS scores on postoperative day 3 were both independently associated with kinesiophobia (both P < 0.01). CONCLUSION: Higher levels of intraoperative noise during hip arthroplasty were significantly associated with short-term kinesiophobia, increased pain perception, fear of movement, and reduced early functional recovery. CLINICAL TRIAL REGISTRATION: www.medicalresearch.org.cn, identifier MR-33-26-021584.