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Persistent pain after knee replacement: Do factors associated with pain vary with degree of patient dissatisfaction?

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)2061-68
JournalOsteoarthritis and Cartilage
Issue number12
Early online date9 Aug 2016
DateAccepted/In press - 27 Jul 2016
DateE-pub ahead of print - 9 Aug 2016
DatePublished (current) - 2016



Objective Up to 20% of patients experience long-term pain and dissatisfaction following knee replacement. The aim of this study was to investigate factors associated with persistent pain following knee replacement and their implications for patient satisfaction. Design A case-controlled analysis compared patients with established persistent pain with patients who were pain-free. 2:1 frequency matching for age (mean 65 SD 9), gender 51:49 M:F), time from surgery (mean 5.7 years SD 1.8) and prosthesis was performed. 1310 patients were approached and 100 patients with persistent pain and 200 matched pain-free controls were included. Variables assessed included mechanical, biological, psychosocial and generalised factors. Results The study found that the degree of dissatisfaction experienced by the patient with persistent pain following knee replacement affected the factors associated with pain. In the most dissatisfied patients, pain was associated with instability in the coronal plane (OR 19.8, 95%CI 3.8-104.0), stiffness (OR 6.4, 95%CI 2.3-18.4) and negative social support (OR 3.3, 95%CI 1.1-10.0). In patients who were less dissatisfied, pain was associated with patellofemoral problems (OR 10.3, 95%CI 3.6-29.6), elevated BMI (OR 2.8, 95%CI 1.4-5.7) and reduced local pain thresholds (OR 4.4, 95%CI 2.0-9.6). Depression (OR 13.6, 95%CI 1.9-96.6) and presence of proximal tibial tenderness (OR 23.5 95%CI 7.8-70.7) were strongly associated with pain regardless of level of satisfaction. Conclusions Patients with persistent pain after knee replacement are dissatisfied. This study identifies factors associated with the worst pain outcomes, which lead to the greatest levels of dissatisfaction. Particular efforts with a holistic multidisciplinary approach should be focused towards these “red flag” factors in order to minimise persistent pain after knee replacement.

    Structured keywords

  • Centre for Surgical Research

    Research areas

  • Knee Replacement, Post surgical pain, Persistent pain, Patient dissatisfaction

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