Assessing the value of systematic screening and early management of neuropathic pain after total knee arthroplasty. A single-center retrospective study - 08/10/26

Doi : 10.1016/j.otsr.2026.104914

Alessander D’Ascoli ^a,⁎ , Martin Sajan ^a, Anissa Belbachir ^b,^c, Michael Akkacha ^c, Philippe Anract ^a

^a Department of Orthopedic Surgery, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex, France

^b Peri-operative Pain Management Unit, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex, France

^c Department of Anesthesia and Intensive Care, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex, France

^⁎ Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 08 October 2026

Abstract

Background

Neuropathic pain is a frequent component of chronic postoperative pain after total knee arthroplasty (TKA) and may remain underdiagnosed. This study evaluated the systematic screening and early management of postoperative neuropathic pain after TKA and described established CPOP risk factors within the affected population.

Hypothesis

The study hypothesis was that early identification and targeted management of neuropathic pain after TKA may lead to favorable clinical outcomes.

Patients and methods

A retrospective, observational, single-center study analyzed patients undergoing total knee arthroplasty by the same surgeon from March 2018 to December 2021. Patients with postoperative neuropathic pain defined as a DN4 score ≥4/10 were followed prospectively and treated. The primary aim was neuropathic pain resolution, defined as a DN2 score <3 (a seven-item symptom questionnaire derived from the DN4) at follow-up without neuropathic pain medications. The secondary objectives were to describe established CPOP risk factors in the NP cohort and peri/post-operative analgesic management with specialist pain team involvement.

Results

A cohort of 402 patients who underwent TKA was enrolled. Postoperatively, 58/402 (14.4%) developed neuropathic pain; follow-up was completed for 42 patients. Women were significantly overrepresented in the analyzed NP cohort (37/42, 88.1%; p < 0.001). Mean age was 67.4 ± 7.6 (46–80), 33/42 (79%) were overweight (mean BMI 29 kg/m²±5.2), with ≥1 established risk factor for postoperative neuropathic pain: prior knee surgery (12/42), chronic pain (12/42), diabetes (8/42), psychiatric conditions (13/42)—anxiety, depression, catastrophizing—or long-term opioid use (9/42). These 42 patients suffering from post-operative neuropathic pain were managed by a specialized team at Cochin Hospital. Treatment within the stepwise protocol most involved antiepileptic drugs (37/42), with frequent use of antidepressants (20/42) and capsaicin patches (26/42).

Discussion

The observed NP rate and CPOP risk-factor profile were consistent with the literature. Nearly two-thirds of analyzed patients met the predefined recovery criteria following systematic screening and multidisciplinary management. However, the absence of a control group precludes causal attribution of these outcomes to the pathway. Prospective controlled studies are required to determine its effect on recovery and symptom control.