Chronic pain after primary total and medial unicompartmental knee arthroplasty for osteoarthritis: a Danish nationwide cross-sectional survey
DOI:
https://doi.org/10.2340/17453674.2025.44898Keywords:
Arthroplasty, Joint replacement, Knee, Knee replacement, Neuropathic painAbstract
Background and purpose: Contemporary data on the risk of chronic pain after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is limited. Therefore, we aimed to investigate the incidence of chronic pain, pain characteristics, patterns of analgesic use, patient satisfaction, and willingness to undergo the same surgery again, 1 year after primary TKA and UKA for osteoarthritis.
Methods: We conducted a nationwide online survey among unselected patients who underwent primary TKA or medial UKA for primary osteoarthritis in Denmark. At 1 year postoperatively, we assessed the incidence of moderate to severe pain (≥ 4 on the 0–10 numerical rating scale), frequency of pain, pain interference with everyday life, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain domain, the Douleur Neuropathique 4 interview (DN4i), use of analgesics, satisfaction, and willingness to undergo the same surgery again.
Results: We sent survey invitations to 2,580 TKA patients and 1,007 UKA patients who underwent surgery in 2022. Of the 70% TKA respondents, 25% had moderate to severe chronic pain, 82% were satisfied/very satisfied with the result of surgery, and 86% indicated that they would choose to undergo surgery again. Of the 75% UKA respondents, 23% had moderate to severe chronic pain, 86% were satisfied/very satisfied, and 88% would undergo the same surgery again.
Conclusion: In Denmark, 25% of TKA patients and 23% of medial UKA patients experienced moderate to severe knee pain after 1 year. These numbers were higher than most previous estimates. Most patients were satisfied with the result of surgery and would undergo the same surgery again.
Downloads
References
Cheng H Y, Beswick A D, Bertram W, Siddiqui M A, Gooberman-Hill R, Whitehouse M R, et al. What proportion of people have long-term pain after total hip or knee replacement? An update of a systematic review and meta-analysis. BMJ Open 2025; 15(5): e088975. doi: 10.1136/bmjopen-2024-088975. DOI: https://doi.org/10.1136/bmjopen-2024-088975
W-Dahl A, Kärrholm J, Rogmark C, Johansson O, Arani P, Mohaddes M, et al. The Swedish Arthroplasty Register Annual Report 2024. SAR; 2025 May 13. doi: 10.18158/l6Qz958RW.
Andrew R, Derry S, Taylor R S, Straube S, Phillips C J. The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain. Pain Pr 2014; 14(1): 79-94. doi: 10.1111/papr.12050. DOI: https://doi.org/10.1111/papr.12050
Inoue K, Ritz B, Arah O A. Causal effect of chronic pain on mortality through opioid prescriptions: application of the front-door formula. Epidemiol Camb Mass 2022; 33(4): 572-80. doi: 10.1097/EDE.0000000000001490. DOI: https://doi.org/10.1097/EDE.0000000000001490
Lindberg-Larsen M, Attarzadeh A P, Kappel A, Bruun C, Wied C, Koppens D, et al. Danish Knee Arthroplasty Register, Annual Report 2022. RKKP. 2023 Sep 30. doi: www.sundk.dk.
Lindberg-Larsen M, Varnum C, Jakobsen T, Andersen M R, Sperling K, Overgaard S, et al. Study protocol for discharge on day of surgery after hip and knee arthroplasty from the Center for Fast-track Hip and Knee Replacement. Acta Orthop 2023; 94: 121-7. doi: 10.2340/17453674.2023.11636. DOI: https://doi.org/10.2340/17453674.2023.11636
Wilson H A, Middleton R, Abram S G F, Smith S, Alvand A, Jackson W F, et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 2019; 364: l352. doi: 10.1136/bmj.l352. DOI: https://doi.org/10.1136/bmj.l352
Laigaard J, Karlsen A, Maagaard M, Haxholdt Lunn T, Mathiesen O, Overgaard S. Perioperative analgesic interventions for reduction of persistent postsurgical pain after total hip and knee arthroplasty: a systematic review and meta-analysis. Anesth Analg 2025; 141(4): 765-78. doi: 10.1213/ANE.0000000000007246 DOI: https://doi.org/10.1213/ANE.0000000000007246
Sharma A, Minh Duc N T, Luu Lam Thang T, Nam N H, Ng S J, Abbas K S, et al. A consensus-based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med 2021; 36(10): 3179-87. doi: 10.1007/s11606-021-06737-1. DOI: https://doi.org/10.1007/s11606-021-06737-1
Schmidt M, Schmidt S A, Sandegaard J L, Ehrenstein V, Pedersen L, Sorensen H T. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7: 449-90. doi: 10.2147/CLEP.S91125. DOI: https://doi.org/10.2147/CLEP.S91125
Pedersen A B, Mehnert F, Odgaard A, Schrøder H M. Existing data sources for clinical epidemiology: the Danish Knee Arthroplasty Register. Clin Epidemiol 2012; 4: 125-35. doi: 10.2147/CLEP.S30050. DOI: https://doi.org/10.2147/CLEP.S30050
Chesworth B M, Mahomed N N, Bourne R B, Davis A M, Ojrr Study Group. Willingness to go through surgery again validated the WOMAC clinically important difference from THR/TKR surgery. J Clin Epidemiol 2008; 61(9): 907-18. doi: 10.1016/j.jclinepi.2007.10.014. DOI: https://doi.org/10.1016/j.jclinepi.2007.10.014
Nikolajsen L, Brandsborg B, Lucht U, Jensen T S, Kehlet H. Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Acta Anaesthesiol Scand 2006; 50(4): 495-500. doi: 10.1111/j.1399-6576.2006.00976.x. DOI: https://doi.org/10.1111/j.1399-6576.2006.00976.x
Chiarotto A, Kaiser U, Choy E, Christensen R, Conaghan P G, Cowern M, et al. Pain measurement in rheumatic and musculoskeletal diseases: where to go from here? Report from a Special Interest Group at OMERACT 2018. J Rheumatol 2019; 46(10): 1355-9. doi: 10.3899/jrheum.181099. DOI: https://doi.org/10.3899/jrheum.181099
Dworkin R H, Turk D C, Farrar J T, Haythornthwaite J A, Jensen M P, Katz N P, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005; 113(1-2): 9-19. doi: 10.1016/j.pain.2004.09.012. DOI: https://doi.org/10.1016/j.pain.2004.09.012
Bellamy N, Buchanan W W, Goldsmith C H, Campbell J, Stitt L W. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15(12): 1833-40.
Wylde V, MacKichan F, Bruce J, Gooberman-Hill R. Assessment of chronic post-surgical pain after knee replacement: development of a core outcome set. Eur J Pain 2015; 19(5): 611-620. doi: 10.1002/ejp.582. DOI: https://doi.org/10.1002/ejp.582
Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005; 114(1): 29. doi: 10.1016/j.pain.2004.12.010. DOI: https://doi.org/10.1016/j.pain.2004.12.010
Finnerup N B, Haroutounian S, Kamerman P, Baron R, Bennett D L H, Bouhassira D, et al. Neuropathic paIn: an updated grading system for research and clinical practice. Pain 2016; 157(8): 1599-606. doi: 10.1097/j.pain.0000000000000492. DOI: https://doi.org/10.1097/j.pain.0000000000000492
Neermark S, Holst C, Bisgaard T, Bay-Nielsen M, Becker U, Tolstrup J S. Validation and calibration of self-reported height and weight in the Danish Health Examination Survey. Eur J Public Health 2019; 29(2): 291-6. doi: 10.1093/eurpub/cky187. DOI: https://doi.org/10.1093/eurpub/cky187
Moore R A, Straube S, Aldington D. Pain measures and cut-offs: ‘no worse than mild pain’ as a simple, universal outcome. Anaesthesia 2013; 68(4): 400-12. doi: https://doi.org/10.1111/anae.12148. DOI: https://doi.org/10.1111/anae.12148
Schünemann H J, Akl E A, Guyatt G H. Interpreting the results of patient reported outcome measures in clinical trials: the clinician’s perspective. Health Qual Life Outcomes 2006; 4: 62. doi: 10.1186/1477-7525-4-62. DOI: https://doi.org/10.1186/1477-7525-4-62
Meyer V M, Benjamens S, Moumni M E, Lange J F M, Pol R A. Global overview of response rates in patient and health care professional surveys in surgery. Ann Surg 2022; 275(1): e75-e81. doi: 10.1097/SLA.0000000000004078. DOI: https://doi.org/10.1097/SLA.0000000000004078
Laigaard J, Aljuboori S M, Nikolajsen L, Mathiesen O, Lunn T H, Overgaard S. Chronic postsurgical pain after primary total hip arthroplasty for osteoarthritis: a nationwide cross-sectional survey study. J Arthroplasty 2025 8; S0883-5403(25)01249-5. doi: 10.1016/j.arth.2025.09.057. DOI: https://doi.org/10.1016/j.arth.2025.09.057
Terradas-Monllor M, Ruiz M A, Ochandorena-Acha M. Postoperative psychological predictors for chronic postsurgical pain after a knee arthroplasty: a prospective observational study. Phys Ther 2024; 104(1): pzad141. doi: 10.1093/ptj/pzad141. DOI: https://doi.org/10.1093/ptj/pzad141
Vossen R J M, Ten Noever De Brauw G V, Bayoumi T, Zuiderbaan H A, Pearle A D. Patient satisfaction following unicompartmental knee arthroplasty: current concepts. J ISAKOS 2024; 9(6): 100349. doi: 10.1016/j.jisako.2024.100349. DOI: https://doi.org/10.1016/j.jisako.2024.100349
Klem N R, Kent P, Smith A, Dowsey M, Fary R, Schütze R, et al. Satisfaction after total knee replacement for osteoarthritis is usually high, but what are we measuring? A systematic review. Osteoarthr Cartil Open 2020; 2(1): 100032. doi: 10.1016/j.ocarto.2020.100032. DOI: https://doi.org/10.1016/j.ocarto.2020.100032
Bertram W, Howells N, White S P, Sanderson E, Wylde V, Lenguerrand E, et al. Prevalence and patterns of neuropathic pain in people with chronic post-surgical pain after total knee arthroplasty. Bone Jt J 2024; 106-B(6): 582-8. doi: 10.1302/0301-620X.106B6.BJJ-2023-0889.R1. DOI: https://doi.org/10.1302/0301-620X.106B6.BJJ-2023-0889.R1
Pedersen C, Troensegaard H, Laigaard J, Koyuncu S, Schrøder H M, Overgaard S, et al. Differences in patient characteristics and external validity of randomized clinical trials on pain management following total hip and knee arthroplasty: a systematic review. Reg Anesth Pain Med 2020; 45(9): 709-15. doi: 10.1136/rapm-2020-101459. DOI: https://doi.org/10.1136/rapm-2020-101459
Arndt K B, Schrøder H M, Troelsen A, Lindberg-Larsen M. Patient-reported outcomes and satisfaction after revisions of medial unicompartmental knee arthroplasties for unexplained pain vs aseptic loosening. Knee Surg Sports Traumatol Arthrosc 2023; 31(11): 4766-72. doi: 10.1007/s00167-023-07483-z. DOI: https://doi.org/10.1007/s00167-023-07483-z
Arndt K B, Schrøder H M, Troelsen A, Lindberg-Larsen M. Patient-reported outcomes and satisfaction 1 to 3 years after revisions of total knee arthroplasties for unexplained pain versus aseptic loosening. J Arthroplasty 2023; 38(3): 535-40.e3. doi: 10.1016/j.arth.2022.10.019. DOI: https://doi.org/10.1016/j.arth.2022.10.019
Khalid S, Mohammad H R, Gooberman-Hill R, Garriga C, Pinedo-Villanueva R, Arden N, et al. Post-operative determinants of chronic pain after primary knee replacement surgery: analysis of data on 258,386 patients from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR). Osteoarthr Cartil Open 2021; 3(1): 100139. doi: 10.1016/j.ocarto.2021.100139. DOI: https://doi.org/10.1016/j.ocarto.2021.100139
Koyuncu S, Friis C P, Laigaard J, Anhøj J, Mathiesen O, Karlsen A P H. A systematic review of pain outcomes reported by randomised trials of hip and knee arthroplasty. Anaesthesia 2021; 76(2): 261-9. doi: 10.1111/anae.15118. DOI: https://doi.org/10.1111/anae.15118
Additional Files
Published
How to Cite
License
Copyright (c) 2025 Jens Laigaard, Saber M Aljuboori, Lone Nikolajsen, Ole Mathiesen, Troels H Lunn, Martin Lindberg-Larsen, Søren Overgaard
This work is licensed under a Creative Commons Attribution 4.0 International License.
