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Longitudinal Postoperative Course of Pain and Dysfunction Following Total Knee Arthroplasty

Hadlandsmyth, Katherine PhD; Zimmerman, M. Bridget PhD; Wajid, Roohina BS; Sluka, Kathleen A. PT, PhD; Herr, Keela PHD, RN, FAAN, AGSF; Clark, Charles R. MD; Noiseux, Nicolas O. MD; Callaghan, John J. MD; Rakel, Barbara A. PhD, RN, FAAN
The Clinical Journal of Pain: Post Acceptance: July 20, 2017
doi: 10.1097/AJP.0000000000000540
Original Article: PDF Only


While the majority of patients undergoing Total Knee Arthroplasty report substantial improvement in pain and function, a significant subset experience persistent post-surgical pain and dysfunction. Better understanding of the longitudinal postoperative course is needed, including the association between patient status following physical rehabilitation at 6 weeks post-TKA, to six month outcomes. This study aims to described the postoperative course of TKA and examine variables associated with change in pain and functioning between 6 weeks and 6 months post-TKA.


In this longitudinal study of 223 participants, assessments of analgesic intake, depression, anxiety, pain catastrophizing, dysfunction, resting and range of motion (ROM) pain, and pain sensitivity were completed at 6 weeks post-TKA. Analgesic intake, pain ratings and dysfunction data were also collected at 6 months post-TKA. Pain and dysfunction ratings were divided into none-mild and moderate–severe categories.


Between 6 weeks and 6 months post-TKA, 75% of the sample stayed in the same pain category, 20% improved, and 5% worsened. In terms of functional changes between 6 weeks and 6 months, 65% of the sample stayed in the same functional category, while 31% improved, and 5% worsened.


These findings demonstrate that the majority of patients’ pain and functioning remains stable between 6 weeks and 6 months post-TKA. However, a notable subset continues to improve or worsen in pain and functioning and the current study identifies variables associated with these changes.

This work was funded by: The National Institutes of Nursing Research (R01 NR009844), the University Of Iowa College Of Nursing, and DJO, Inc. Dr. Sluka serves as a consultant for DJO, Inc. There are no other conflicts of interest to report.

Reprints: Katherine Hadlandsmyth, PhD, University of Iowa Hospitals and Clinics, 8476 JCP, Department of Anesthesia, 200 Hawkins Drive, Iowa City, IA 52242 (e-mail:

Received November 15, 2016

Accepted July 10, 2017

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