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Post-operative patient-related risk factors for chronic pain after total knee replacement: a systematic review

Research output: Contribution to journalArticle

Original languageEnglish
Article numbere018105
Number of pages13
JournalBMJ Open
Issue number11
Early online date3 Nov 2017
DateAccepted/In press - 15 Sep 2017
DateE-pub ahead of print - 3 Nov 2017
DatePublished (current) - Nov 2017



To identify post-operative patient-related risk factors for chronic pain after total knee replacement (TKR).


The systematic review protocol was registered on PROSPERO (CRD42016041374). MEDLINE, Embase and PsycINFO were searched from inception to October 2016 with no language restrictions. Key articles were also tracked in ISI Web of Science. Cohort studies evaluating the association between patient-related factors in the first three months post-operative and pain at six months or longer after primary TKR surgery were included. Screening, data extraction and assessment of methodological quality were undertaken by two reviewers.The primary outcome was pain severity in the replaced knee measured with a patient-reported outcome measure at six months or longer after TKR. Secondary outcomes included adverse events and other aspects of pain recommended by the core outcome set for chronic pain after TKR.


After removal of duplicates, 16,430 articles were screened, of which 805 were considered potentially relevant. After detailed evaluation of full-text articles, 14 studies with data from 1,168 participants were included. Post-operative patient-related factors included acute pain (eight studies), function (five studies) and psychosocial factors (four studies). The included studies had diverse methods for assessment of potential risk factors and outcomes and therefore narrative synthesis was conducted. For all post-operative factors, there was insufficient evidence to draw firm conclusions about the association with chronic pain after TKR. Selection bias was a potential risk for all studies, as none were reported to be conducted at multiple centres.


This systematic review found insufficient evidence to draw firm conclusions about the association between any post-operative patient-related factors and chronic pain after TKR. Further high-quality research is required to provide a robust evidence base on post-operative risk factors, and inform the development and evaluation of targeted interventions to optimise patients’ outcomes after TKR.

    Research areas

  • total knee replacement, post operative risk factors, chrob=nic pain, systematic review

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