Clinical Orthopaedics and Related Research®

, Volume 471, Issue 1, pp 162–168 | Cite as

Is Pain and Dissatisfaction After TKA Related to Early-grade Preoperative Osteoarthritis?

  • Gregory G. PolkowskiII
  • Erin L. Ruh
  • Toby N. Barrack
  • Ryan M. Nunley
  • Robert L. Barrack
Symposium: Papers Presented at the Annual Meetings of the Knee Society



There is growing evidence to suggest many patients experience pain and dissatisfaction after TKA. The relationship between preoperative osteoarthritis (OA) severity and postoperative pain and dissatisfaction after TKA has not been established.


We explored the relationship between early-grade preoperative OA with pain and dissatisfaction after TKA by (1) determining the incidence of early-grade preoperative OA in painful TKAs with no other identifiable abnormality; and (2) comparing this incidence with the incidence of early-grade OA in three other cohorts of patients undergoing TKA.


We evaluated all (n = 49) painful TKAs in a 1-year period that had no evidence of loosening, instability, malalignment, infection, or extensor mechanism dysfunction and classified the degree of preoperative OA according to the scale of Kellgren and Lawrence. For comparison, we identified three other cohorts of TKAs from the same center and classified their preoperative grade of OA: Group B (n = 100) was a consecutive series of primary TKAs performed for OA during the same year; Group C (n = 80) were asymptomatic TKAs from 1 to 4 years postoperatively; and Group D (n = 80) were TKAs with some degree of pain at 1 to 4 years postoperatively.


Patients in Group A had a higher incidence of early-grade OA is preoperatively (49%) compared with any of the comparison groups: Group B, 5%; Group C, 6%; and Group D, 10%.


A high percentage of patients referred for unexplained pain after TKA had early-grade osteoarthritis preoperatively. Patients undergoing TKA for less than Grade 3 or 4 OA should be informed that they may be at higher risk for persistent pain and dissatisfaction.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.


Joint Space Narrowing Unicompartmental Knee Arthroplasty Anterior Knee Pain Knee Society Scoring Preoperative Radiograph 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Angel Poucher for assistance with manuscript preparation.


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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Gregory G. PolkowskiII
    • 1
  • Erin L. Ruh
    • 2
  • Toby N. Barrack
    • 2
  • Ryan M. Nunley
    • 2
  • Robert L. Barrack
    • 2
  1. 1.Department of Orthopedic SurgeryNew England Musculoskeletal Institute, University of Connecticut Health CenterFarmingtonUSA
  2. 2.Department of Orthopaedic SurgeryWashington University School of Medicine/Barnes-Jewish HospitalSt LouisUSA

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