Predicting Pain in Total and Partial Knee Arthroplasty


Object: Although pain relief is a primary goal of a total knee arthroplasty (TKA) and partial knee arthroplasty (PKA), a significant number of arthroplasty patients experience unexplained pain. This study attempts to determine preoperative or intraoperative factors that may predict pain after knee arthroplasty. Methods: 2585 primary TKAs and 423 PKAs were performed between 1993 and 2013. Infections, loosening, and revision arthroplasty were excluded. Knee Society scores, demographics, component sizes, pre- and postoperative alignment, treatment of the posterior cruciate ligament, range of motion, and diagnosis were analyzed. Statistical analysis utilized repeated measures ANOVA. Results: Significant predictors of increased pain after TKA were pre-operative varus alignment >5° (p = 0.0042), postoperative flexion range of motion <105° (p < 0.0001), postoperative flexion contracture >5° (p = 0.0006), small tibial component sizes (p = 0.0080), excision of the posterior cruciate ligament (p = 0.0259), and diagnosis as osteonecrosis (p = 0.0077). Factors not associated with pain included age, body mass index, gender, postoperative alignment and bone quality. For PKA, age was the only factor associated with pain. Conclusions: Six factors were found to be relevant to postoperative pain in TKA. For PKA, reported pain is not associated with any of the same factors, but is associated with age. Surgeons should be aware of these risk factors as we continue to understand pain after total and partial knee arthroplasty.

Share and Cite:

Sueyoshi, T. , Lackey, W. , Malinzak, R. , Meding, J. , Farris, A. , Davis, K. and Ritter, M. (2015) Predicting Pain in Total and Partial Knee Arthroplasty. Open Journal of Orthopedics, 5, 151-156. doi: 10.4236/ojo.2015.56020.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Brander, V.A., Malhotra, S., Jet, J., Heinemann, A.W. and Stulberg, S.D. (1997) Outcome of Hip and Knee Arthroplasty in Persons Aged 80 Years and Older. Clinical Orthopedics Related Research, 345, 67-78.
[2] Breugem, S.J., Sierevelt, I.N., Schafroth, M.U., et al. (2008) Less Anterior Knee Pain with a Mobile-Bearing Prosthesis Compared with a Fixed-Bearing Prosthesis. Clinical Orthopedics Related Research, 466, 1959-1965.
[3] Brander, V.A., Stulberg, S.D., Adams, A.D., et al. (2003) Predicting Total Knee Replacement Pain: A Prospective, Observational Study. Clinical Orthopedics Related Research, 416, 27-36.
[4] Chaudhary, R., Beaupré, L.A. and Johnston, D.W. (2008) Knee Range of Motion during the First Two Years after Use of Posterior Cruciate-Stabilizing or Posterior Cruciate-Retaining Total Knee Prostheses. A Randomized Clinical Trial. The Journal of Bone and Joint Surgery (American), 90, 2579-2586.
[5] Elson, D.W. and Brenkel, I.J. (2006) Predicting Pain after Total Knee Arthroplasty. Journal of Arthroplasty, 21, 1047-1053.
[6] Forsythe, M.E., Dunbar, M.J., Hennigar, A.W., et al. (2008) Prospective Relation between Catastrophizing and Residual Pain Following Knee Arthroplasty: Two-Year Follow-Up. Pain Research & Management, 13, 335-341.
[7] Gandhi, R., Davey, J.R. and Mahomed, N. (2009) Patient Expectations Predict Greater Pain Relief with Joint Arthroplasty. Journal of Arthroplasty, 24, 716-721.
[8] Hawker, G., Wright, J., Coyte, P., et al. (1998) Health-Related Quality of Life after Knee Replacement. The Journal of Bone and Joint Surgery (American), 80, 163-173.
[9] Kim, J., Nelson, C.L. and Lotke, P.A. (2004) Stiffness after Total Knee Arthroplasty. Prevalence of the Complication and Outcomes of Revision. The Journal of Bone and Joint Surgery (American), 86, 1479-1484.
[10] Lavernia, C., D’Apuzzo, M., Rossi, M.D. and Lee, D. (2009) Is Postoperative Function After Hip or Knee Arthroplasty Influenced by Preoperative Functional Levels? Journal of Arthroplasty, 24, 1033-1043.
[11] Lingard, E.A., Katz, J.N., Wright, E.A. and Sledge, C.B., Kinemax Outcomes Group (2004) Predicting the Outcome of Total Knee Arthroplasty. The Journal of Bone and Joint Surgery (American), 86, 2179-2186.
[12] Mont, M.A., Serna, F.K., Krackow, K.A. and Hungerford, D.S. (1996) Exploration of Radiographically Normal Total Knee Replacements for Unexplained Pain. Clinical Orthopedics Related Research, 331, 216-220.
[13] Noble, P.C., Conditt, M.A., Cook, K.F. and Mathis, K.B. (2006) The John Insall Award: Patient Expectations Affect Satisfaction with Total Knee Arthroplasty. Clinical Orthopedics Related Research, 452, 35-43.
[14] Ritter, M.A. and Campbell, E.D. (1987) Effect of Range of Motion on the Success of a Total Knee Arthroplasty. Journal of Arthroplasty, 2, 95-97.
[15] Ritter, M.A., Harty, L.D., Davis, K.E., Meding, J.B. and Berend, M.E. (2003) Predicting Range of Motion after Total Knee Arthroplasty. Clustering, Log-Linear Regression, and Regression Tree Analysis. The Journal of Bone and Joint Surgery (American), 85, 1278-1285.
[16] Ritter, M.A., Lutgring, J.D., Davis, K.E., Berend, M.E., Pierson, J.L. and Meneghini, R.M. (2007) The Role of Flexion Contracture on Outcomes in Primary Total Knee Arthroplasty. Journal of Arthroplasty, 22, 1092-1096.
[17] Ritter, M.A., Thong, A.E., Davis, K.E., Berend, M.E., Meding, J.B. and Faris, P.M. (2004) Long-Term Deterioration of Joint Evaluation Scores. The Journal of Bone and Joint Surgery (British), 86, 438-442.
[18] Santaguida, P.L., Hawker, G.A., Hudak, P.L., Glazier, R., Mahomed, N.N., Kreder, H.J., et al. (2008) Patient Characteristics Affecting the Prognosis of Total Hip and Knee Joint Arthroplasty: A Systematic Review. Canadian Journal of Surgery, 51, 428-436.
[19] Seon, J.K., Park, S.J., Lee, K.B., Yoon, T.R., Kozanek, M. and Song, E.K. (2009) Range of Motion in Total Knee Arthroplasty: A Prospective Comparison of High-Flexion and Standard Cruciate-Retaining Designs. The Journal of Bone and Joint Surgery (American), 91, 672-679.
[20] Whiteside, L.A. (1991) The Effect of Patient Age, Gender, and Tibial Component Fixation on Pain Relief after Cementless Total Knee Arthroplasty. Clinical Orthopedics Related Research, 271, 21-27.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.