Prediction of total knee arthroplasty outcome based on psychophysical tests

Introduction. Osteoarthritis is the most prevalent joint disease worldwide, with knee osteoarthritis representing its most common form. Pain in knee osteoarthritis is known to have neuropathic components; however, the mechanisms leading to central sensitization remain incompletely understood. It is also unclear whether surgical pain relief achieved through total knee arthroplasty results in modulation of central sensitization and neuropathic pain. Quantitative sensory testing in the prediction of postoperative pain after total knee arthroplasty. Sensory profiling using quantitative sensory testing modalities - particularly temporal summation and conditioned pain modulation - has emerged as a valuable approach for identifying patients with osteoarthritis who are at risk of acute and chronic postsurgical pain. These modalities, when combined with other parameters, may facilitate individualized pain management strategies. Preoperative hyperalgesia and neuropathic pain features, detected through temporal summation testing and Pain- DETECT questionnaires, have demonstrated predictive value for the development of chronic postsurgical pain after total knee arthroplasty. Patients exhibiting centrally mediated pain mechanisms and established central sensitization tend to experience less postoperative pain relief following total knee arthroplasty. Female sex has been associated with higher magnitude of conditioned pain modulation and an increased prevalence of severe acute and chronic postsurgical pain, identifying it as a potential risk factor for pain chronification. Conclusion. Quantitative sensory testing modalities - particularly temporal summation, conditioned pain modulation, and pressure pain threshold - appear to be the most promising tools for predicting postoperative pain outcomes using quantitative sensory testing. Patients with evidence of central sensitization show reduced pain relief after total knee arthroplasty.