This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA .
BACKGROUND Total knee arthroplasty ( TKA ) is a common and costly surgical procedure .
Despite high success rates , many TKA patients develop chronic pain  in the months and years following surgery , constituting a public health burden .
Pain catastrophizing is a construct that reflects anxious preoccupation with pain , inability to inhibit pain-related fears , amplification of the significance of pain vis-à-vis health implication s , and a sense of helplessness regarding pain .
Recent research suggests that it may be an important risk factor for untoward TKA outcomes .
To clarify this impact , we systematic ally review ed the literature to date on pain catastrophizing as a prospect i ve predictor of chronic pain following TKA .
Predicting pain after total knee arthroplasty.
Six hundred twenty-two primary total knee arthroplasties were studied prospect ively in 512 patients . A group with no pain and one with severe pain at 5 years were statistically compared . The following were significant predictors of poor pain outcomes :  age below 60 ( 17 % ) compared with above 60 ( 7 % , P < .05 ) . The first knee was most likely to be in the poor outcome group ( 13 % ) compared with the second knee ( 6 % ) . In contrast , patients who underwent simultaneous bilateral arthroplasty faired better ( 2 % , P < .01 ) . Performing lateral release and sacrificing the posterior cruciate ligament also significantly predicted for poor pain outcomes but may have been influenced by selection bias . We conclude that avoiding surgery in patients younger than 60 and choosing a simultaneous approach to bilateral disease reduce the chance of poor pain outcomes
This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA .
BACKGROUND Total knee arthroplasty ( TKA ) is a common and costly surgical procedure .
Despite high success rates , many TKA patients develop chronic pain  in the months and years following surgery , constituting a public health burden .
Pain catastrophizing is a construct that reflects anxious preoccupation with pain , inability to inhibit pain-related fears , amplification of the significance of pain vis-à-vis health implication s , and a sense of helplessness regarding pain .
Recent research suggests that it may be an important risk factor for untoward TKA outcomes .
To clarify this impact , we systematic ally review ed the literature to date on pain catastrophizing as a prospect i ve predictor of chronic pain following TKA .