Catastrophism and anxiety are risk factors of chronic pain after total knee arthroplasty

Listen to Simon and Amy discuss the paper 'Catastrophism and anxiety are risk factors of chronic pain after total knee arthroplasty' published in the July 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper, 'Catastrophism and anxiety are risk factors of chronic pain after total knee arthroplasty', published in July 2025 by C Croppi and colleagues. I'm Simon, and I'm joined by my co-host Amy.

Hello Simon. I'm looking forward to delving into this topic today. Chronic pain after total knee arthroplasty or TKA is a significant issue. Could you start us off with a bit of background on why this research was undertaken?

Certainly, Amy. So globally, approximately 365 million people suffer from osteoarthritis with about 10 million in France alone. Due to the aging population and rising obesity rates, these numbers are expected to increase. TKA is a well-established surgical intervention for advanced osteoarthritis of the knee. In 2018, 113,600 TKA procedures were performed in [00:01:00] France with projections suggesting this number will rise to 150,000 by 2050.

While the surgery itself is generally successful with a satisfaction rate exceeding 75%, a significant proportion of patients between 20 and 40% continue to suffer from chronic pain post-surgery, which can greatly impact their quality of life. This study aimed to identify psychosocial risk factors such as anxiety and catastrophizing, that contribute to this persistent pain and determine optimal threshold values for these risks.

The research was a single-centre prospective study conducted at Lariboisière Hospital in France from September 2022 to September 2023. They involved 204 patients with an average age of 70 years, and about 70% of them were female.

The team utilized several psychological assessment tools such as the Hospital Anxiety and Depression Scale, HADS, the State-Trait Anxiety Inventory, STAI-Y, the Amsterdam Preoperative Anxiety and Information [00:02:00] Scale, APAIS, and the Pain Catastrophizing Scale, PCS. These were combined with a visual analog scale, VAS, for pain assessment.

Yes and one of the more notable results was that 17.60% of patients experienced chronic pain at six months postoperatively, defined as a VAS score of four or higher. Their multivariate analysis revealed that being an employee or manual worker, having high anxiety scores and high catastrophizing scores were significantly associated with chronic pain.

They determined specific threshold values using receiver operating characteristic, ROC, curve analysis. For example, on the STAI-Y anxiety scale, a score of 44.5 out of 80 was identified as a threshold with a sensitivity of 57.58%, and specificity of 74.51%. For the PCS scale, a score of 21.5 out of 52 showed similar predictive power.

Indeed, that was quite interesting. This [00:03:00] threshold identification means clinicians can better predict which patients are at higher risk for chronic pain post-TKA. The study emphasized the importance of a multidimensional approach to patient assessment and management integrating psychosocial evaluations into preoperative care to improve long-term outcomes.

And Simon, isn't it fascinating how the study also highlighted the role of socioeconomic factors? For instance, being a homeowner or earning over 2000 euros per month seem to have a protective effect against developing chronic pain. However, these turned out to be non-significant in the multi-variate model, suggesting that broader socioeconomic conditions might indirectly influence anxiety levels.

Absolutely. Amy. While technical advancements in surgery are crucial, addressing psychosocial factors might play a vital role in reducing the incidence of chronic pain. Early detection and management of anxiety and catastrophizing could become an integral part of pre-surgical routines.

In summary, this study strongly supports [00:04:00] the view that psychosocial factors like anxiety and pain catastrophizing, significantly influence the risk of chronic pain post-TKA. Identifying thresholds for these factors can help clinicians provide targeted preoperative interventions potentially improving patient outcomes.

Precisely Amy, thanks for joining me in this insightful discussion. Thank you,

Simon and thanks to our listeners for tuning in to AI talks with Bone & Joint.

Until next time.