JOA - 2026-06-19 - Journal Article
Pain Catastrophizing Improves After Total Knee Arthroplasty, But Still Has a Negative Effect on Outcomes in Japanese Patients.
Kubo T, Kinoshita T, Kutsuna T, Watamori K, Hino K, Takao M
Topics
Key Takeaway
In 267 Japanese TKA patients, one-year postoperative PCS independently predicted KSS satisfaction (β = -0.390, p < 0.001) even after controlling for VAS pain, and six-month PCS independently predicted one-year satisfaction (β = -0.241, p = 0.014).
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Summary
This study examined longitudinal PCS trajectories and their association with KSS satisfaction in 267 Japanese TKA patients using linear mixed-effects models and multivariable regression. PCS improved significantly between 6 weeks and 6 months postoperatively, but VAS plateaued after 6 weeks. Both concurrent one-year PCS (β = -0.390) and prospective six-month PCS (β = -0.241) independently predicted one-year KSS satisfaction after adjustment for pain intensity.
Key Limitation
The study is a single-center Japanese cohort, and PCS normative values and catastrophizing prevalence differ across ethnicities, limiting direct application of these beta coefficients and thresholds to Western TKA populations.
Original Abstract
BACKGROUND
Preoperative pain catastrophizing has been reported to influence postoperative outcomes in total knee arthroplasty (TKA). However, little is known about how catastrophizing changes after surgery. This study assessed the longitudinal changes in pain catastrophizing following TKA and its clinical impact.
METHODS
We included 267 patients who underwent TKA and assessed the Pain Catastrophizing Scale (PCS) preoperatively and at postoperative day seven, six weeks, six months, and one year. Patients undergoing bilateral TKA or contralateral knee surgery within one year before or after TKA were excluded. Outcomes included PCS, the 2011 Knee Society Score (KSS), and visual analog scale (VAS). Temporal changes were analyzed using linear mixed-effects models. There were two multivariable linear regression models constructed to evaluate concurrent associations and prospective predictors of one-year KSS satisfaction.
RESULTS
In the mixed-effects model, PCS showed a modest, but statistically significant improvement from six weeks to six months, whereas VAS did not change significantly after six weeks. In the concurrent model, both the one-year postoperative PCS (β = -0.390, P < 0.001) and VAS (β = -0.166, P = 0.021) were independently associated with the one-year KSS satisfaction score. In the prospective model, the six-month PCS (β = -0.241, P = 0.014) and VAS (β = -0.229, P = 0.018) independently predicted patient satisfaction at one year.
CONCLUSION
Pain catastrophizing improved after TKA but remained independently associated with patient satisfaction at one year, even after adjustment for pain intensity. The PCS at six months was also associated with later satisfaction, suggesting that patient-perceived outcomes may reflect psychological dimensions beyond pain severity alone.