Acute postoperative pain following hospital discharge after total knee arthroplasty

Osteoarthritis Cartilage. 2013 Sep;21(9):1257-63. doi: 10.1016/j.joca.2013.06.011.


Objective: The increasingly shorter hospitalization following total knee arthroplasty (TKA) requires patients to assume earlier responsibility to self-manage their pain. Poorly managed acute pain increases the risk of persistent pain, reduces quality of life and increases unnecessary healthcare utilization. This study aims to examine post-discharge pain intensity, pain management behaviors and potential barriers to optimal self-management of pain.

Design: We administered a questionnaire at 2 weeks after discharge to 174 patients undergoing TKA in 10 Australian hospitals. Participants rated pain expectation and severity, use of analgesics and non-pharmacological methods, side-effects, walking and exercise times, perceptions of analgesics, adequacy of pain management information provided and satisfaction with pain relief.

Results: Of 171 (98%) participants who completed the questionnaire, 88 (52%) reported that the worst pain period occurred during the first 2 weeks at home. During the first 2 weeks at home, the average pain was 'severe/extreme' for 40 (23%) participants and 92 (54%) experienced severe pain at least some of the time. Many participants sought further medical help for their pain. Adequate information on analgesics and non-pharmacological methods for pain relief were reported by only 73% and 47%, respectively. Approximately 20% had negative perceptions about analgesic use. Higher pain severity was associated with lower satisfaction and less time spent walking daily.

Conclusions: Effective pain relief after hospital discharge following TKA is a challenge. Many participants reported significant pain, sought further medical help for pain relief and had inadequate information at discharge to effectively self-manage their postoperative knee pain.

Keywords: Acute pain; Analgesics; Knee arthroplasty; Non-pharmacological methods; Pain management; Surveys.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Pain / diagnosis
  • Acute Pain / drug therapy
  • Acute Pain / epidemiology*
  • Aged
  • Analgesics / administration & dosage
  • Analgesics / adverse effects
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Exercise
  • Female
  • Health Surveys
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / epidemiology*
  • Osteoarthritis, Knee / surgery*
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / epidemiology*
  • Patient Discharge
  • Patient Satisfaction
  • Risk Factors
  • Self Care
  • Surveys and Questionnaires


  • Analgesics