Preoperative neuropathic-like pain and central sensitisation are risk factors for chronic pain after total knee arthroplasty: A systematic review and meta-analysis.

Objective: To investigate the effects of preoperative neuropathic-like pain and central sensitisation on clinical outcomes after total knee arthroplasty (TKA). Design: This systematic review and meta-analysis followed PRISMA guidelines and was prospectively registered. Studies were included if they assessed preoperative neuropathic-like pain or central sensitisation before TKA and clinical outcomes after surgery, such as pain, function, or psychological status. Cross-sectional studies and case reports were excluded. Two authors independently screened, extracted data and rated articles' quality using a quality assessment tool. A meta-analysis was performed for studies reporting comparable methods and outcomes. Results: From 6061 identified records, 15 studies met the inclusion criteria (total sample: 2385 individuals; follow-up periods: less than 1 year to 5 years). Most studies exhibited low/moderate risk of bias, primarily due to small sample sizes. The risk ratio of chronic pain (VAS ≥3 after at least 3 months) was 2.75 (CI: 1.78; 4.26) for patients with neuropathic-like pain (PainDETECT score ≥13). Seven out of eleven studies identified neuropathic-like pain and central sensitisation as risk factors for clinical outcomes such as decreased self-reported function, satisfaction, and anxiety (p ​< ​0.05). Studies that adjusted for covariates showed mixed results, with some losing statistical significance. Conclusion: The presence of neuropathic-like pain and central sensitisation in candidates for TKA is a risk factor for postoperative chronic pain. Evidence for decreased function, satisfaction, and psychological conditions is inconsistent. Screening and managing neuropathic-like pain and central sensitisation preoperatively could possibly improve clinical outcomes. Further research with standardized methods is needed. Prospero id: CRD42024622693.