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Clin J Pain. 2019 Apr 3. doi: 10.1097/AJP.0000000000000714. [Epub ahead of print]

Presurgical Comorbidities as Risk Factors for Chronic Postsurgical Pain Following Total Knee Replacement.

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Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Orthopaedic Research Unit, Aalborg University Hospital, Aalborg Denmark.
Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Denmark.



Chronic postsurgical knee-pain (CPSP) is a burden for approx. 20% of the patients following total knee replacement (TKR). Presurgical pain intensities have consistently been found associated with CPSP and it is suggested that e.g. comorbidities are likewise important for development of CPSP. This study aimed to identify presurgical risk factors for development of CPSP 5 years after TKR based on medical records containing information regarding comorbidities.


Patients undergoing primary TKR surgery were contacted 5 years after TKR. Presurgical Knee Society Score and comorbidities were evaluated. Postsurgical knee-pain at 5-years follow-up was assessed on a numeric rating scale (NRS, 0-10). Logistic regression models were utilized to identify patients with moderate-to-severe (NRS≥3) and mild-to-no (NRS<3) CPSP at 5-year follow-up. An odds ratio (OR) for significant factors were calculated.


A total of 604 patients were contacted, 493 patients responded, 352 patients provided a complete questionnaire. A total of 107 patients reported NRS≥3 at follow-up.Significant presurgical factors associated with CPSP were fibromyalgia (OR 20.66, P=0.024), chronic pain in other body parts than the knee (OR 6.70, P=0.033), previous diagnosis of cancer (OR 3.06, P=0.001), knee instability (OR 2.16, P=0.021), age (OR 2.15, P=0.007), and presurgical knee-pain (OR 1.61, P=0.044). Regression analysis identified 36 out of 107 (33.6%) patients with CPSP based on presurgical factors, and 231 patients (94.3%) without CPSP were classified correct.


The current study found that a variety of presurgical clinical factors can correctly classify 33.6% of patients at risk for developing CPSP 5 years following TKR.

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