Patient-centred Insights Into Persistent Pain After Total Knee Joint Replacement: A Qualitative Synthesis

Abstract

Purpose Approximately 10-30% of people experience persistent pain following total knee replacement (TKR). Understanding the long-term experiences of pain post-TKR is crucial for optimising patient-centred care and guiding management. This study aimed to qualitatively synthesise existing research on patients’ lived experiences of persistent pain following TKR.

Materials and methods A search strategy was implemented across four databases to identify qualitative studies on patient experiences of persistent pain following TKR. The Critical Appraisal Skills Programme checklist was used for quality assessment. Data from selected articles were analysed using a thematic synthesis approach, involving an iterative process of coding, descriptive theme development, and analytical theme development.

Results Eight studies were included in the synthesis, with four analytical themes constructed: (1) Unexpected symptoms and unexplained pain, leading to anxiety and distress, (2) Loss of embodiment, related to foreignness and lack of trust in the knee, (3) Lack of interest from the health system, highlighting the disconnect with healthcare providers, and (4) Facilitating acceptance of pain, describing the personal and healthcare system factors that promote reconceputalisation of pain.

Conclusions Several individual and system factors are proposed that may break the cycle of pain and distress and facilitate better outcomes.