Preoperative Determinants of Patient-reported Pain and Physical Function Levels Following Total Knee Arthroplasty: A Systematic Review

E. Lungu1, *, P-A. Vendittoli2, 3, F. Desmeules2, 4
1 Department of Biomedical Sciences, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
2 Centre de recherche de l’Hôpital Maisonneuve-Rosemont, 5415 Boul. L’Assomption, Montreal, Québec, Canada, H1T 2M4
3 Surgery Department, Maisonneuve-Rosemont Hospital, University of Montréal Affiliated Research Center, 5415 Boul. L’Assomption, Montréal, Québec, Canada, H1T 2M4
4 School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 835
Abstract HTML Views: 294
PDF Downloads: 259
ePub Downloads: 154
Total Views/Downloads: 1542
Unique Statistics:

Full-Text HTML Views: 593
Abstract HTML Views: 216
PDF Downloads: 196
ePub Downloads: 127
Total Views/Downloads: 1132

Creative Commons License
© Lungu et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montréal, Québec, Canada, H3C 3J7; E-mail:



A sound knowledge of the determinants of total knee arthroplasty (TKA) outcomes could help in patient selection, preparation and education. We aimed to assess the current status of the literature evaluating preoperative determinants of early and medium term patient-reported pain and disability following TKA.


A search in Medline, Pubmed, Embase and CINAHL until October 2014 was undertaken. Selection criteria included: 1- participants undergoing primary unilateral TKA with a follow-up from 6 months to 2 years, 2- validated disease-specific patient-reported outcome measures assessing pain and/or function used as outcome measure and 3- identification of preoperative determinants obtained via multivariate analyses. Risk of bias was assessed using a modified version of the Methodology checklist for prognostic studies.


Thirty-three prognostic explanatory studies were included. Mean total score of the methodological quality was 80.7±12.2 %. Sociodemographic and psychosocial determinants included greater socioeconomic deprivation (both studies), greater levels of depression and/or anxiety (7 out of 10 studies) and greater preoperative pain catastrophizing (all 3 studies). Significant clinical determinants included worse pre-operative knee related pain or disability (20 out of 22 studies), presence or greater levels of comorbidity (12 out of 23 studies), back pain (4 out of 5 studies) and lower general health (all 11 studies).


Several significant determinants of short to medium-term pain and functional outcomes following TKA have been summarized by studies with moderate-to-high methodological quality. No conclusions can be reached regarding the strength of the associations between significant determinants and TKA results because of heterogeneity of study methodologies and results. Further high-quality research is required.

Keywords: Determinant, Functional limitation, Knee osteoarthritis, Postoperative pain, Total knee arthroplasty.