Potential Role of Peri-operative Cognitive Behavioral Therapy on Pain and Joint Function After Total Knee...

Postoperative pain is reported as a major complication of total knee arthroplasty (TKA) and is found in about 20% of the patients. The persistent pain is considered the main reason for dissatisfaction after surgery. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of peri-operative cognitive behavioral therapy (CBT) in postoperative pain relief and restoration of joint function.

RCTs (published in English) that compared the outcomes of patients who underwent TKA with or without peri-operative CBT were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science. Main endpoints, namely Oxford Knee Score (OKS), knee joint range of motion (ROM) and EuroQol five dimensions questionnaire (EQ-5D), were pooled and assessed by RevMan.

Six RCTs mainly focused on TKA were included in the meta-analysis. Compared with the conventional care group, the CBT group had lower OKS at three months (SMD = - 0.47, 95% CI - 1.50, 0.55) and 12 months (SMD = - 0.78, 95% CI - 1.76, 0.21) and improved knee ROM at 12 months (SMD = 4.19, 95% CI - 3.77, 12.15), but not at 7 days (SMD = 0.07, 95% CI - 0.24, 0.38) or 3 months (SMD = 0.24, 95% CI - 0.07, 0.55) after TKA. In addition, the CBT group showed better EQ-5D performance at three months (SMD = - 0.67, 95% CI - 4.97, 1.64) and 12 months (SMD = - 1.38, 95% CI - 3.37, 0.61) after TKA.

Peri-operative CBT is partially effective for improving pain, functional recovery, psychological conditions and ROM after TKA.

The online version contains supplementary material available at 10.1007/s43465-025-01553-9.