Welcome to Francis Academic Press

Frontiers in Medical Science Research, 2023, 5(8); doi: 10.25236/FMSR.2023.050802.

Risk factors of chronic pain after total knee arthroplasty: a meta-analysis


Xinjian Ai1, Yin Yang1,2, Xinyu Zhang1

Corresponding Author:
Yin Yang

1School of Nursing, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China

2The Second Department of Orthopedics, Xi’an Central Hospital, Xi’an, Shaanxi, China


We systematically searched the Cochrane Library, EMbase, PubMed, Web of Science, China Journal Full-text Database (CNKI), Wanfang Digital Journal Full-text Database (Wanfang) and VIP journal Resource integration Service platform (VIP) database for published literature studies on the risk factors for chronic post-surgical pain (CPSP) in total knee arthroplasty (TKA) patients. The search period is up to March 10, 2023. Literature screening and data extraction were conducted independently by two researchers according to inclusion and exclusion criteria. After quality evaluation, meta-analysis was performed using Review Manager 5.3 software. Finally, 17 literatures were included. The results of meta-analysis showed that female [OR=1.32,95% CI(1.18,1.48),P<0.001], preoperative pain [OR= 1.76,95%CI(1.54,2.01),P<0.001], extensive pain[OR=3.11,95%CI(2.07,4.68),P<0.001], preoperative anxiety (OR = 2.80, 95% CI (0.83, 17.30), P < 0.001), preoperative depression (OR = 1.15, 95% CI (1.33, 5.87), P = 0.003] were TKA patients CPSP risk factors. Therefore, Clinical staff should identify and intervene in patients with high risk of CPSP after TKA as early as possible to reduce its incidence.


Total knee arthroplasty; Chronic postoperative pain; Risk factors; Meta-analysis; Evidence-based nursing

Cite This Paper

Xinjian Ai, Yin Yang, Xinyu Zhang. Risk factors of chronic pain after total knee arthroplasty: a meta-analysis. Frontiers in Medical Science Research (2023) Vol. 5, Issue 8: 7-13. https://doi.org/10.25236/FMSR.2023.050802.


[1] Liu Wei, Li Wenlong, Ding Juan, et al. Research progress on non-operative influencing factors of chronic pain after total knee replacement [J]. Journal of Traditional Chinese Medicine Bone Orthopaedics, 2022, 34(08):59-61. 

[2] A S S, Patricia L, Antonia B, et al. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. [J]. Pain, 2019, 160(1). 

[3] Rodrigo N, Claudio C, Maritza O, et al. Social determinants associated to chronic pain after total knee arthroplasty. [J]. International orthopaedics, 2019, 43(12). 

[4] Andreas S. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. [J]. European journal of epidemiology, 2010, 25(9). 

[5] Xiantao Z, Yonggang Z, W K J S, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. [J]. Journal of evidence-based medicine, 2015, 8(1). 

[6] Wan Guoli, Shi Chenhui, Wang Weishan, et al. Retrospective analysis of the influencing factors of chronic pain after total knee replacement [J]. Journal of Tissue Engineering Research, 2019, 27(04): 558-564. (in Chinese)

[7] Luo Haiping, Tian Meimei. Analysis of influencing factors and construction of prediction model of chronic pain after total knee arthroplasty [J]. Journal of Nursing Research, 2002, 36(07):1281-1286. 

[8] Long Dandan, Yang Xinlu, Hu Jicheng, et al. Relationship between extensive pain and chronic pain after total knee arthroplasty in patients with knee osteoarthritis [J]. Chinese Journal of Anesthesiology, 2002, 42(8):945-948. 

[9] Chen Jieru, Hu Jicheng, Chen Jiaqi, et al. Correlation between preoperative pain catastrophization and chronic pain after total knee arthroplasty [J]. Journal of Clinical Anesthesiology, 2012, 38(7): 721-725. (in Chinese)

[10] Zhang Jinjun, Liang Chengjie, Li Weihong, et al. Perioperative risk factors for chronic pain after primary unilateral total knee replacement [J]. Journal of Sun Yat-sen University (Medical Sciences), 2019, 42(06):906-912. (in Chinese)

[11] Ding Wanlan. Analysis of influencing factors of chronic pain after total knee replacement [J]. Nursing Practice and Research, 2021, 18(23):3516-3519. 

[12] Chen Fan, Wang Di, Yang Xinlu, et al. Relationship between preoperative plasma angiotensin ⅱ-2 receptor concentration and chronic pain after total knee arthroplasty [J]. Journal of Clinical Anesthesiology, 2021, 37(05):475-479. 

[13] Hardy A, Sandiford M H, Menigaux C, et al. Pain catastrophizing and pre-operative psychological state are predictive of chronic pain after joint arthroplasty of the hip, knee or shoulder: results of a prospective, comparative study at one year follow-up[J]. International Orthopaedics, 2022, 46(11): 2461-2469. 

[14] Hasegawa M, Tone S, Naito Y, et al. Preoperative pain catastrophizing affects pain outcome after total knee arthroplasty[J]. Journal of Orthopaedic Science, 2022, 27(5):1096-1099. 

[15] Aso K, Ikeuchi M, Takaya S, et al. Chronic postsurgical pain after total knee arthroplasty: A prospective cohort study in Japanese population[J]. Modern Rheumatology, 2021, 31(5): 1038-1044. 

[16] Gungor S, Fields K, Aiyer R, et al. Incidence and risk factors for development of persistent postsurgical pain following total knee arthroplasty: A retrospective cohort study[J]. Medicine (Baltimore), 2019, 98(28):e16450. 

[17] Skrejborg P, Petersen K K, Kold S, et al. Presurgical Comorbidities as Risk Factors For Chronic Postsurgical Pain Following Total Knee Replacement[J]. Clin J Pain, 2019, 35(7):577-582. 

[18] Thomazeau J, Rouquette A, Martinez V, et al. Predictive Factors of Chronic Post-Surgical Pain at 6 Months Following Knee Replacement: Influence of Postoperative Pain Trajectory and Genetics[J]. Pain Physician, 2016, 19(5):E729-E741. 

[19] Attal N, Masselin-Dubois A, Martinez V, et al. Does cognitive functioning predict chronic pain? Results from a prospective surgical cohort [J]. BRAIN, 2014, 137:904-917. 

[20] Aveline C, Le Roux A, Le Hetet H, et al. Pain and Recovery After Total Knee Arthroplasty A 12-Month Follow-up After a Prospective Randomized Study Evaluating Nefopam and Ketamine for Early Rehabilitation[J]. Clinical Journal of Pain, 2014, 30(9):749-754. 

[21] Liu S S, Buvanendran A, Rathmell J P, et al. A cross-sectional survey on prevalence and risk factors for persistent postsurgical pain 1 year after total hip and knee replacement[J]. Reg Anesth Pain Med, 2012, 37(4):415-422. 

[22] Puolakka P, Rorarius M, Roviola M, et al. Persistent pain following knee arthroplasty[J]. European Journal of Anaesthesiology, 2010, 27(5):455-460. 

[23] B F R. Individual differences in pain: understanding the mosaic that makes pain personal. [J]. Pain, 2017, 158 Suppl 1(Suppl 1). 

[24] Sveikata T, Porvaneckas N, Kanopa P, et al. Age, Sex, Body Mass Index, Education, and Social Support Influence Functional Results After Total Knee Arthroplasty[J]. Geriatric Orthopaedic Surgery & Rehabilitation, 2017, 8(2). 

[25] Wood T J, Thornley P, Petruccelli D, et al. Preoperative Predictors of Pain Catastrophizing, Anxiety, and Depression in Patients Undergoing Total Joint Arthroplasty[J]. The Journal of Arthroplasty, 2016, 31(12). 

[26] Sun Xin, Li Guangzhao, Sun Ynuo, et al. Research progress of chronic pain after total knee arthroplasty [J]. Journal of PLA Nursing, 2019, 37(10):71-73. (in Chinese)

[27] LC B, SE R, MK F, et al. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review[J]. Journal of Pain Research, 2015, 2015(default). 

[28] Wang Chunsheng, Yang Pei, Zhang Ziqi, et al. Effect of pain catastrophization on the outcome of knee arthroplasty [J]. Chinese Journal of Joint Surgery, 2014, 8(06):698-701. (in Chinese)

[29] Song Chunyan, Wu Hongyan, Dai Hongmei, et al. A phenomenological study on psychological experience of outpatient patients with chronic pain [J]. Journal of Nursing Science, 2017, 32(23):81-84. (in Chinese)

[30] Wang Desheng. Effect of preoperative depression on postoperative pain and function in patients with total knee replacement [D]. Zhengzhou University, 2019. 

[31] Li J. Pain and depression comorbidity: A preclinical perspective[J]. Behavioural Brain Research, 2015, 276.