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. 2025 Mar 19;37(1):13.
doi: 10.1186/s43019-025-00263-8.

The impact of central sensitization on perioperative pain in TKA: a retrospective cohort study

Tatsuru Sonobe  1 , Takuya Nikaido  2 , Miho Sekiguchi  1 , Yoichi Kaneuchi  1 , Tadashi Kikuchi  3 , Yoshihiro Matsumoto  1
Affiliations

The impact of central sensitization on perioperative pain in TKA: a retrospective cohort study

Tatsuru Sonobe et al. Knee Surg Relat Res. .

Abstract

Background: Total knee arthroplasty (TKA) is an established surgical procedure for severe knee osteoarthritis (KOA) that has provided excellent outcomes. While several studies have reported that patients with preoperative central sensitization (CS) experienced worse pre- and post-operative pain and outcomes, the evidence is limited. We conducted this study to determine the impact of CS on perioperative knee pain in TKA for severe KOA.

Methods: A retrospective cohort study of 66 patients who underwent bilateral TKA for bilateral severe KOA was conducted. Multiple linear regression models that included covariates and scaled estimated regression coefficients were used to examine the impact of CS on the patients' pre- and post-operative pain subscale values on the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the improvement of KOOS pain. Postoperative KOOS pain was assessed at 3 months postoperatively, while other evaluation items including preoperative KOOS pain, CS, and pain self-efficacy were assessed on admission.

Results: CS had a negative impact on pre- and post-operative KOOS pain (preoperative, β: -0.28, 95% confidence interval [CI] -18.53, -0.92; postoperative, β: -0.26, 95%CI -14.09, -0.44; p < 0.05). High pain self-efficacy had a positive impact on preoperative KOOS pain (β: 0.25, 95%CI 0.32, 18.08; p < 0.05). However, CS did not influence the improvement of KOOS pain.

Conclusions: These results demonstrate that CS had a negative impact on pre- and post-TKA knee pain in patients but did not affect the improvement of knee pain. TKA provides sufficient pain relief for severe KOA, with or without CS. Further research is required to improve pre- and post-operative knee pain in KOA patients with CS.

Keywords: Central sensitization; KOOS pain; Knee osteoarthritis; Self-efficacy; Total knee arthroplasty.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Written informed consent for the use of the data collected in this study was obtained from all subjects upon enrollment. The study complied with the Declaration of Helsinki and was approved by the research ethics committee of our university (no. 2022-175). Consent to publication: Informed consent was obtained from all individual subjects included in the study. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The asterisk (*) indicates (p)-values < 0.05. The pre- and post-operative KOOS pain scores were significantly lower in the C group compared with the N group, but there was no significant difference in improvement of KOOS pain
See this image and copyright information in PMC

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