Pain in the Forecast: Investigating Weather Sensitivity Before and After Total Knee Arthroplasty

While many patients report that their symptoms are influenced by weather conditions prior to their knee arthroplasty (TKA), how weather-related pain (WRP) evolves following surgery remains poorly understood. This study investigated the prevalence of WRP prior to and after TKA, assessed whether TKA resolves preoperative WRP, evaluated the incidence of new-onset WRP postoperatively, and identified associated risk factors.

We prospectively surveyed 87 patients (121 TKAs) at a mean follow-up of 9 years (range: 1-26 years). Patients completed a standardized questionnaire assessing WRP before and after surgery, along with patient-reported outcome measures (WOMAC, UCLA activity score, and SF-12). Statistical analysis was performed to assess the associations between WRP and clinical or demographic variables, as well as patient-reported outcome measures (PROMs) in patients with and without WRP.

Preoperatively, 31% of patients (37/121 knees) reported WRP. Following TKA, WRP resolved in 48% of these cases (18/37 knees), persisted in 16% (19/121 knees), and developed de novo in 16% of patients (20 knees). Postoperative WRP was significantly associated with the presence of WRP in other joints (p < 0.0001), and with female sex (p < 0.0008). Preoperatively, patients with WRP had worse WOMAC scores for pain (p = 0.046), stiffness (p = 0.012), and physical function (p = 0.024). Despite these differences, all groups demonstrated significant improvement in PROMs postoperatively, with no differences between groups at final follow-up (p > 0.125).

TKA leads to the resolution of WRP in nearly half of affected patients; however, a subset develops new or persistent WRP. Female sex, and multi-joint involvement are associated with WRP after TKA. These findings underscore the importance of preoperative counseling regarding expectations for pain relief, particularly in relation to weather sensitivity.