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Updated: Jul 14, 2026

Tissue Collection and RNA Extraction from the Human Osteoarthritic Knee Joint
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Tissue Collection and RNA Extraction from the Human Osteoarthritic Knee Joint

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Total knee replacement: is it really an effective procedure for all?

V Wylde1, P Dieppe, S Hewlett

  • 1University of Bristol, Department of Orthopaedic Surgery, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK. V.Wylde@bristol.ac.uk

The Knee
|June 29, 2007
PubMed
Summary

Many patients experience persistent pain and disability after total knee replacement (TKR). Identifying pre-operative risk factors is crucial for improving outcomes in TKR surgery.

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Area of Science:

  • Orthopedic Surgery
  • Pain Management
  • Patient Outcomes Research

Background:

  • Total knee replacement (TKR) is a common procedure for chronic knee pain.
  • A significant number of patients report ongoing pain, disability, and dissatisfaction post-TKR.
  • Medically unexplained pain and disability after TKR are significant concerns.

Purpose of the Study:

  • To explore patient-related factors contributing to poor outcomes after TKR.
  • To identify predictors of medically unexplained pain and disability following TKR.
  • To inform the development of pre-operative screening protocols for TKR.

Main Methods:

  • Review of patient-based outcome measures and existing research.
  • Analysis of socio-demographic, medical, and psychological factors associated with TKR outcomes.

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Tissue Collection and RNA Extraction from the Human Osteoarthritic Knee Joint
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  • Consideration of biological mechanisms like central sensitization.

    • Main Results:

    • Female gender, older age, and lower socioeconomic status correlate with poorer TKR outcomes.
    • Higher comorbidity burden and worse pre-operative status predict post-TKR pain and disability.
    • Psychological factors (depression, low self-efficacy, poor coping, somatization, low social support, expectations) are predictive.
    • Central sensitization is a proposed biological mechanism for persistent pain.

    Conclusions:

    • Patient factors significantly influence outcomes after TKR, beyond surgical aspects.
    • Pre-operative identification of at-risk patients is essential for optimizing TKR success.
    • Future research should focus on developing screening tools to mitigate medically unexplained post-TKR pain and disability.