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The Role of Preoperative Radiological Severity, Sensory Testing, and Temporal Summation on Chronic Postoperative Pain following Total Knee Arthroplasty

Petersen, Kristian Kjær PhD, MSc; Simonsen, Ole PhD; Laursen, Mogens Berg PhD; Arendt-Nielsen, Lars DMSc, PhD
The Clinical Journal of Pain: Post Acceptance: June 16, 2017
doi: 10.1097/AJP.0000000000000528
Original Article: PDF Only


Knee osteoarthritis (KOA) can be associated with local and central sensitization. As an indicator of the central gain, facilitated temporal summation of pain (TSP) has been found in KOA patients. This facilitation is predictive of the development of chronic postoperative pain after total knee arthroplasty (TKA). Other studies have suggested hypoesthesia/hypoalgesia to thermal stimuli as a feature in KOA. This study investigated associations between preoperative TSP, thermal sensitivity and radiological severity for the development of chronic postoperative pain after TKA.


Radiological KOA (Kellgren & Lawrence, KL), TSP, and thermal stimuli were collected preoperatively. Clinical knee pain intensity (VAS 0-10) was assessed before and 12 months following TKA. Subjects were categorized into a chronic postoperative pain group if they experienced less than 30% pain reduction of the initial pain after 12 months.


19% of the subjects were categorized as chronic pain subjects and presented facilitated preoperative TSP (P<0.05) and a trend towards increased heat pain threshold (P=0.077) compared with subjects with normal recovery. Pearson correlations found that preoperative TSP (R=0.193, P=0.013), KL (R=−0.168, P=0.027), warm detection threshold (R=0.195, P=0.012), and heat pain threshold (R=0.196, P=0.012) were associated with pain intensity 12 months after TKA where TSP was identified as an independent factor.


This study showed that preoperatively facilitated TSP in KOA patients was predictive of the development of chronic postoperative pain following TKA. Furthermore, this study is the first to find an association between preoperative hypoalgesia to heat and the development of chronic postoperative pain following TKA.

Original paper for: Clinical Journal of Pain.

Article type: Clinical/Basic Science Research Report.

Source of Funding: The Danish Rheumatism Association, The Innovation Fund Denmark ( 136-2014-5), and The Shionogi Science Program are acknowledged for providing the opportunity to conduct the study. None of the funding sources played a role in the investigation.

The authors declare no conflict of interest.

Reprints: Lars Arendt-Nielsen, PhD, DMSc, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7 D3, DK-9220 Aalborg, Denmark (e-mail: LAN@HST.AAU.DK).

Received March 31, 2017

Accepted June 11, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.