ArticleThe Journal of arthroplasty2024
Central Sensitization: The Missing Link Between Psychological Distress and Poor Outcome Following Primary Total Knee Arthroplasty.
Article in The Journal of arthroplasty, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Pain Mechanisms and Psychosocial Variables in Patients With Chronic Pain After Total Knee Arthroplasty: Secondary Analysis From a Randomised Controlled Trial.European journal of pain (London, England) · 2025Trial
- Association between preoperative central sensitization-related symptoms and poor postoperative pain improvement after total knee arthroplasty: an exploratory analysis.International orthopaedics · 2026Article
- Decision-making experience of elderly patients for joint replacement surgery in China: a qualitative study.BMJ open · 2025Article
- Neurobiology of Chronic Pain, Posttraumatic Stress Disorder, and Mild Traumatic Brain Injury.Biology · 2025Review
- The Influence of Preoperative Central Sensitization on the Postoperative Prognosis of Pilon Fractures: A Retrospective Study.Journal of pain research · 2025Article
- Redesigning the Care of Musculoskeletal Conditions With Lifestyle Medicine.Mayo Clinic proceedings. Innovations, quality & outcomes · 2024Article
- Effect of central sensitization on postoperative cognitive dysfunction in total knee arthroplasty patients: a retrospective study.Frontiers in neurology · 2024Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundWhile preoperative psychological distress is known to predict risk for worse total knee arthroplasty (TKA) outcomes, distress may be too broad and nonspecific a predictor in isolation. We tested whether there are distinct preoperative TKA patient types based jointly on psychological status and measures of altered pain processing that predict adverse clinical outcomes.
methodsIn 112 TKA patients, we preoperatively assessed psychological status (depression, anxiety, and catastrophizing) and altered pain processing via a simple quantitative sensory testing protocol capturing peripheral and central pain sensitization. Outcomes (pain, function, opioid use) were prospectively evaluated at 6 weeks and 6 months after TKA. Cluster analyses were used to empirically identify TKA patient subgroups.
resultsThere were 3 distinct preoperative TKA patient subgroups identified from the cluster analysis. A low-risk (LR) group was characterized by low psychological distress and low peripheral and central sensitization. In addition, 2 subgroups with similarly elevated preoperative psychological distress were identified, differing by pain processing alterations observed: high-risk centralized pain and high-risk peripheral pain. Relative to LR patients, high-risk centralized pain patients displayed significantly worse function and greater opioid use at 6 months after TKA (P values <.05). The LR and high-risk peripheral pain patient subgroups had similar 6-month outcomes (P values >.05).
conclusionsAmong patients who have psychological comorbidity, only patients who have central sensitization were at elevated risk for poor functional outcomes and increased opioid use. Central sensitization may be the missing link between psychological comorbidity and poor TKA clinical outcomes. Preoperative testing for central sensitization may have clinical utility for improving risk stratification in TKA patients who have psychosocial risk factors.
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