• Sebastian Bierke and Wolf Petersen.
• Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin Grunewald, Caspar Theyss Strasse 27-31, 14 193, Berlin, Germany.
• Arch Orthop Trauma Surg. 2017 Dec 1; 137 (12): 1735-1742.

PurposeProlonged postoperative pain is a frequent problem after uncomplicated total knee replacement (TKR). The purpose of this study was to evaluate the effect of anxiety and pain catastrophizing on postoperative pain after TKR.MethodsA total of 150 patients were enrolled in this prospective study. Preoperatively, anxiety was assessed using the State-Trait Anxiety Inventory (STAI) and pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). The primary outcome measure was postoperative pain on a numerical rating scale (NRS). The secondary outcome parameters were the different Knee Osteoarthritis Outcome Score (KOOS) subscales and patient satisfaction. Intergroup differences were tested with an independent t test. The odds ratio was calculated to determine the probability of an unsatisfactory outcome.ResultsPreoperatively and at 6 and 12 months postoperatively, patients with anxiety and particularly patients with pain catastrophizing usually had a higher NRS score, lower knee function before and after surgery, and higher dissatisfaction. These intergroup differences were significant preoperatively and at 6 months postoperatively.ConclusionsPsychopathologic factors, particularly pain catastrophizing, have an impact on postoperative pain after TKR. Preoperative screening and concurrent treatment of the diagnosed psychological disorder may improve patient-perceived outcomes.

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