Pain catastrophising and resilience influence outcomes following total knee arthroplasty

Aim: <br/>To examine correlations between pre-operative pain catastrophising and resilience with post-operative outcomes in primary total knee arthroplasty (TKA) patients. <br/><br/>Design: <br/>Systematic review <br/><br/>Methods: <br/>Five databases were systematically searched from inception until July 2024. Cohort studies investigating correlations between pre-operative pain catastrophising or resilience and post-operative outcomes in TKA patients were included. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Results of individual studies were extracted and described through narrative and tabular synthesis. Study comparisons between pre-operative psychological measures and post-operative outcomes were grouped and reported on. <br/><br/>Results: <br/>Fourteen studies (2,506 patients) of overall moderate methodological quality were included. Pain catastrophising showed statistically significant correlations with postoperative pain intensity and self-reported functional outcomes in 8/10 and 7/9 studies, respectively. Lower pre-operative resilience was associated with reduced postoperative self-reported function and physical performance in 2/3 studies. However, neither pain catastrophising nor resilience demonstrated consistent correlations with objective physical performance measures, analgesic requirements, other psychometric outcomes, or length of hospital stay. <br/><br/>Conclusion: <br/>Pre-operative pain catastrophising consistently influences post-operative pain and functional outcomes following TKA, while resilience's impact was less conclusive.<br/><br/>Key practice points: <br/>• Pre-operative psychological screening, particularly for pain catastrophising, may <br/>identify patients at risk of suboptimal outcomes who could benefit from targeted <br/>psychological interventions before undergoing TKA. <br/>• Patients with high pain catastrophising may require additional support during <br/>rehabilitation, as their heightened pain perception can lead to avoidance <br/>behaviours that limit functional recovery and compromise surgical outcomes.