Advancing the understanding of preoperative factors and patient experiences related to pain and physical function after total knee arthroplasty

Abstract

Total Knee Arthroplasty (TKA) is a commonly performed surgical procedure for treating knee osteoarthritis. Despite its prevalence, a significant number of patients continue to suffer from chronic post-surgical pain and impaired function following the surgery. The overarching aim of this thesis was to advance the understanding of preoperative factors and patient experiences related to pain and function after TKA. A meta-analysis of pain outcome one year after TKA identified that higher levels of preoperative pain catastrophizing, more severe pain, and more symptomatic joints were correlated with more severe postoperative pain one year after surgery. At the five-year follow-up with evidence from a prospective observational study, the same factors, with the exception of pain catastrophizing, were correlated with more severe pain. More severe radiographic osteoarthritis was correlated with less pain at both one and five years after the surgery. In a meta-analysis examining function outcomes one year after TKA, a correlation was estimated between higher preoperative body mass index and poorer function post-surgery. More severe radiographic osteoarthritis was correlated with better function. Furthermore, in a prospective observational study, more severe preoperative anxiety was correlated with worse pain-related functional impairment, whereas male sex was correlated with better functional outcome five years after TKA. In a qualitative study, participants without pain improvement one year after TKA, described stories of living with persistent pain or psychosocial stress in years before surgery. The findings from this thesis emphasize the importance of including prognostic factors in future predictive models for TKA outcomes. The study also underscores the need to integrate patient experiences for effective pre-surgical knee osteoarthritis management.