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Meta-Analysis
. 2023 Mar 24;18(3):e0283446.
doi: 10.1371/journal.pone.0283446. eCollection 2023.

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

Unni Olsen  1   2 , Maren Falch Lindberg  1   2 , Christopher Rose  3   4 , Eva Denison  3 , Caryl Gay  5   6 , Arild Aamodt  2 , Jens Ivar Brox  7   8 , Øystein Skare  2 , Ove Furnes  9   10 , Kathryn A Lee  5 , Anners Lerdal  6   11
Affiliations
Meta-Analysis

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

Unni Olsen et al. PLoS One. .

Abstract

Main objective: Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis.

Methods: Based on a peer-reviewed protocol, we searched Medline, Embase, CINAHL, Cochrane Library, and PEDro for prospective observational studies (January 2000 to February 2023) investigating factors associated with pain after TKA. The primary outcome was pain twelve months after TKA. Pain at three and six months were secondary outcomes. Multivariate random-effects meta-analyses were used to estimate mean correlation (95% CIs) between factors and pain. Sensitivity analysis was performed for each risk of bias domain and certainty of evidence was assessed.

Results: Of 13,640 studies, 29 reports of 10,360 patients and 61 factors were analysed. The mean correlation between preoperative factors and more severe pain at twelve months was estimated to be 0.36 (95% CI, 0.24, 0.47; P < .000; moderate-certainty evidence) for more catastrophizing, 0.15 (95% CI; 0.08, 0.23; P < .001; moderate-certainty evidence) for more symptomatic joints, 0.13 (95% CI, 0.06, 0.19; P < .001; very low-certainty evidence) for more preoperative pain. Mean correlation between more severe radiographic osteoarthritis and less pain was -0.15 (95% CI; -0.23, -0.08; P < .001; low-certainty evidence). In sensitivity analysis, the estimated correlation coefficient for pain catastrophizing factor increased to 0.38 (95% CI 0.04, 0.64). At six and three months, more severe preoperative pain was associated with more pain. Better preoperative mental health was associated with less pain at six months.

Conclusion and relevance: More pain catastrophizing, more symptomatic joints and more pain preoperatively were correlated with more pain, while more severe osteoarthritis was correlated with less pain one year after TKA. More preoperative pain was correlated with more pain, and better mental health with less pain at six and three months. These findings should be further tested in predictive models to gain knowledge which may improve TKA outcomes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of included studies.
Fig 2
Fig 2. Forest plot of factors associated with pain at twelve months.
Fig 3
Fig 3. Forest plot of factors associated with pain at six months.
Fig 4
Fig 4. Forest plot of factors associated with pain at three months.
See this image and copyright information in PMC

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