Association between preoperative central sensitization-related symptoms and poor postoperative pain improvement after total knee arthroplasty: an exploratory analysis.

Junji Nishimoto, Yoshihiro Takiguchi, Ryota Imamura, Taketo Shiraoka, Ryo Tanaka

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Article in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 authors.

Junji NishimotoDepartment of Rehabilitation, Faculty of Health Sciences, Tokyo Kasei University, Sayama, Japan. nishimoto-j@tokyo-kasei.ac.jp.

Yoshihiro TakiguchiDepartment of Rehabilitation, Hiroshima Clinic, Hiroshima, Japan.

Ryota ImamuraDepartment of Rehabilitation, Hiroshima Clinic, Hiroshima, Japan.

Taketo ShiraokaDepartment of Rehabilitation, Kawagoe Clinic, Saitama Medical University, Kawagoe, Japan.

Ryo TanakaGraduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima, Japan.

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6 · The paper itself

Abstract

purposeHigher preoperative Central Sensitization Inventory (CSI) scores may be associated with poor pain improvement after total knee arthroplasty (TKA); sex differences in this association remain unclear. We investigated whether sex modifies the association between preoperative CSI scores and pain improvement after TKA.

methodsThis multicenter prospective cohort study included patients undergoing primary unilateral TKA. Poor postoperative pain improvement at three months after TKA was defined as failure to achieve the minimal clinically important difference (10 points) on the Knee injury and Osteoarthritis Outcome Score pain subscale. Logistic regression analyses were performed to examine associations between preoperative CSI scores and poor pain improvement, including an interaction term between CSI scores and sex, with adjustment for age, body mass index, pain intensity, pain catastrophizing, anxiety, and depression.

resultsOf 210 enrolled patients (48 males, 162 females; mean age, 73.8 ± 7.8 years), 192 were included. Higher preoperative CSI scores were associated with greater odds of poor postoperative pain improvement (odds ratio, 1.115; 95% confidence interval [CI], 1.060-1.173; P <0.001), whereas sex was not associated with the outcome. In the interaction model, higher CSI scores remained associated with poor pain improvement (OR, 1.142; 95% CI, 1.026-1.271; P = 0.015), whereas neither sex (OR, 1.022; 95% CI, 0.380-2.751; P = 0.966) nor the CSI × sex interaction term (OR, 0.973; 95% CI, 0.873-1.084; P = 0.615) was associated with the outcome.

conclusionsHigher preoperative CSI scores were associated with poor postoperative pain improvement after TKA, without a sex interaction.

Indexed as

Arthroplasty, Replacement, KneeCentral Nervous System SensitizationOsteoarthritis, KneePostoperative PainAgedAged, 80 and overFemaleHumansMalePain MeasurementPreoperative PeriodProspective StudiesSex FactorsTreatment OutcomeCentral sensitizationKnee osteoarthritisPainSex differencesTotal knee arthroplasty

Identifiers

PMID42250147

DOI10.1007/s00264-026-06891-3

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