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Background <p>Postoperative pain is reported as a major complication of total knee arthroplasty (TKA) and is found in about 20% of the patients. The persistent pain is considered the main reason for dissatisfaction after surgery. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of peri-operative cognitive behavioral therapy (CBT) in postoperative pain relief and restoration of joint function.</p> Methods <p>RCTs (published in English) that compared the outcomes of patients who underwent TKA with or without peri-operative CBT were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science. Main endpoints, namely Oxford Knee Score (OKS), knee joint range of motion (ROM) and EuroQol five dimensions questionnaire (EQ-5D), were pooled and assessed by RevMan.</p> Results <p>Six RCTs mainly focused on TKA were included in the meta-analysis. Compared with the conventional care group, the CBT group had lower OKS at three months (SMD = −&#xa0;0.47, 95% CI −&#xa0;1.50, 0.55) and 12&#xa0;months (SMD = −&#xa0;0.78, 95% CI −&#xa0;1.76, 0.21) and improved knee ROM at 12&#xa0;months (SMD = 4.19, 95% CI −&#xa0;3.77, 12.15), but not at 7&#xa0;days (SMD = 0.07, 95% CI −&#xa0;0.24, 0.38) or 3&#xa0;months (SMD = 0.24, 95% CI −&#xa0;0.07, 0.55) after TKA. In addition, the CBT group showed better EQ-5D performance at three months (SMD = −&#xa0;0.67, 95% CI −&#xa0;4.97, 1.64) and 12&#xa0;months (SMD = −&#xa0;1.38, 95% CI −&#xa0;3.37, 0.61) after TKA.</p> Conclusion <p>Peri-operative CBT is partially effective for improving pain, functional recovery, psychological conditions and ROM after TKA.</p>

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Potential Role of Peri-operative Cognitive Behavioral Therapy on Pain and Joint Function After Total Knee Arthroplasty: A Meta-analysis

  • 期刊论文

  • 发表日期：

    2025年9月2日

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  • Yanan Kong,
  • Shuaicheng An,
  • Weixin Zhang,
  • Shuai Wu,
  • Senbo An

摘要

Background

Postoperative pain is reported as a major complication of total knee arthroplasty (TKA) and is found in about 20% of the patients. The persistent pain is considered the main reason for dissatisfaction after surgery. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of peri-operative cognitive behavioral therapy (CBT) in postoperative pain relief and restoration of joint function.

Methods

RCTs (published in English) that compared the outcomes of patients who underwent TKA with or without peri-operative CBT were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science. Main endpoints, namely Oxford Knee Score (OKS), knee joint range of motion (ROM) and EuroQol five dimensions questionnaire (EQ-5D), were pooled and assessed by RevMan.

Results

Six RCTs mainly focused on TKA were included in the meta-analysis. Compared with the conventional care group, the CBT group had lower OKS at three months (SMD = − 0.47, 95% CI − 1.50, 0.55) and 12 months (SMD = − 0.78, 95% CI − 1.76, 0.21) and improved knee ROM at 12 months (SMD = 4.19, 95% CI − 3.77, 12.15), but not at 7 days (SMD = 0.07, 95% CI − 0.24, 0.38) or 3 months (SMD = 0.24, 95% CI − 0.07, 0.55) after TKA. In addition, the CBT group showed better EQ-5D performance at three months (SMD = − 0.67, 95% CI − 4.97, 1.64) and 12 months (SMD = − 1.38, 95% CI − 3.37, 0.61) after TKA.

Conclusion

Peri-operative CBT is partially effective for improving pain, functional recovery, psychological conditions and ROM after TKA.