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EFORT Open Rev. 2018 Aug 16;3(8):461-470. doi: 10.1302/2058-5241.3.180004. eCollection 2018 Aug.

Chronic pain after total knee arthroplasty.

Author information

Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK.
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, UK.
North Bristol NHS Trust, Southmead Hospital, Bristol, UK.


Despite a good outcome for many patients, approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA).Chronic pain after TKA can affect all dimensions of health-related quality of life, and is associated with functional limitations, pain-related distress, depression, poorer general health and social isolation.In both clinical and research settings, the approach to assessing chronic pain after TKA needs to be in-depth and multidimensional to understand the characteristics and impact of this pain. Assessment of this pain has been inadequate in the past, but there are encouraging trends for increased use of validated patient-reported outcome measures.Risk factors for chronic pain after TKA can be considered as those present before surgery, intraoperatively or in the acute postoperative period. Knowledge of risk factors is important to guide the development of interventions and to help to target care. Evaluations of preoperative interventions which optimize pain management and general health around the time of surgery are needed.The causes of chronic pain after TKA are not yet fully understood, although research interest is growing and it is evident that this pain has a multifactorial aetiology, with a wide range of possible biological, surgical and psychosocial factors that can influence pain outcomes.Treatment of chronic pain after TKA is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristics is advocated. To ensure that optimal care is provided to patients, the clinical- and cost-effectiveness of multidisciplinary and individualized interventions should be evaluated. Cite this article: EFORT Open Rev 2018;3:461-470. DOI: 10.1302/2058-5241.3.180004.


aetiology; assessment; chronic pain; epidemiology; impact; risk factors; total knee arthroplasty; treatment

Conflict of interest statement

ICMJE Conflict of interest statement: A. Blom declares grant funding from Stryker, activity outside the submitted work.

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