ArticleBMJ open2022
Progression of chronic pain and associated health-related quality of life and healthcare resource use over 5 years after total knee replacement: evidence from a cohort study.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 32 citations in OpenAlex.
- Development of risk prediction model for chronic pain after knee replacement surgery: protocol for an individual patient data meta-analysis.Perioperative medicine (London, England) · 2026Article
- Long-Term Trajectories of Patient-Reported Outcomes Following Total Knee Arthroplasty: A Longitudinal Study of 1,264 Patients.The Journal of bone and joint surgery. American volume · 2026Article
- Article
- PainDETECT as a Potential Tool for Personalized Medicine: Predicting Outcome One Year After Knee Arthroplasty.Mayo Clinic proceedings. Innovations, quality & outcomes · 2025Article
- Preoperative Clinical Phenotyping for Individualised Rehabilitation in End-Stage Knee Osteoarthritis.Journal of functional morphology and kinesiology · 2025Article
- The experience of surgeons treating unexplained pain after knee arthroplasty : a reflexive thematic analysis.Bone & joint open · 2025Article
- Modelled cost-effectiveness analysis of the Support and Treatment After Replacement (STAR) care pathway for chronic pain after total knee replacement compared with usual care.Cost effectiveness and resource allocation : C/E · 2024Article
- Factors associated with pain and functional impairment five years after total knee arthroplasty: a prospective observational study.BMC musculoskeletal disorders · 2024Observational
- "I am accustomed to something in my body causing pain": a qualitative study of knee replacement non-improvers' stories of previous painful and stressful experiences.BMC musculoskeletal disorders · 2023Article
- A Linear Decomposition Approach to Explain Excess Direct Healthcare Expenditures Associated with Pain Among Adults with Osteoarthritis.Health services insights · 2022Article
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveAs part of the STAR Programme, a comprehensive study exploring long-term pain after surgery, we investigated how pain and function, health-related quality of life (HRQL), and healthcare resource use evolved over 5 years after total knee replacement (TKR) for those with and without chronic pain 1 year after their primary surgery.
methodsWe used data from the Clinical Outcomes in Arthroplasty Study prospective cohort study, which followed patients undergoing TKR from two English hospitals for 5 years. Chronic pain was defined using the Oxford Knee Score Pain Subscale (OKS-PS) where participants reporting a score of 14 or lower were classified as having chronic pain 1-year postsurgery. Pain and function were measured with the OKS, HRQL using the EuroQoL-5 Dimension, resource use from yearly questionnaires, and costs estimated from a healthcare system perspective. We analysed the changes in OKS-PS, HRQL and resource use over a 5-year follow-up period. Multiple imputation accounted for missing data.
resultsChronic pain was reported in 70/552 operated knees (12.7%) 1 year after surgery. The chronic pain group had worse pain, function and HRQL presurgery and postsurgery than the non-chronic pain group. Those without chronic pain markedly improved right after surgery, then plateaued. Those with chronic pain improved slowly but steadily. Participants with chronic pain reported greater healthcare resource use and costs than those without, especially 1 year after surgery, and mostly from hospital readmissions. 64.7% of those in chronic pain recovered during the following 4 years, while 30.9% fluctuated in and out of chronic pain.
conclusionAlthough TKR is often highly beneficial, some patients experienced chronic pain postsurgery. Although many fluctuated in their pain levels and most recovered over time, identifying people most likely to have chronic pain and supporting their recovery would benefit patients and healthcare systems.
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