Preoperative Central Sensitization as a Predictor of Pain Outcomes After Hip and Knee Arthroplasty: A Systematic Review

Persistent pain remains a common clinical challenge after hip and knee arthroplasty, even when surgical outcomes are technically successful, with growing recognition that altered central pain processing, particularly central sensitization (CS), may contribute to unfavorable postoperative outcomes. This systematic review evaluated whether preoperative CS predicts poor pain-related outcomes after hip and knee arthroplasty. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library from database inception to the final search date, identifying observational studies that assessed CS using validated instruments such as the Central Sensitization Inventory (CSI) and quantitative sensory testing (QST) in patients undergoing total knee arthroplasty (TKA), unicompartmental knee arthroplasty, revision knee arthroplasty, or total hip arthroplasty (THA). Extracted outcomes included postoperative pain intensity, functional outcomes, patient satisfaction, analgesic consumption, development of chronic postsurgical pain, and achievement of minimal clinically important differences (MCIDs), while methodological quality was evaluated using the Newcastle-Ottawa Scale (NOS). Nine observational studies met the inclusion criteria, and across these studies, preoperative CS was consistently associated with higher postoperative pain intensity, an increased risk of chronic postsurgical pain, a lower likelihood of achieving clinically meaningful pain improvement, greater use of analgesics, and reduced patient satisfaction. In contrast, patients without evidence of CS experienced superior pain relief and functional recovery across all follow-up periods, including short-, mid-, and long-term. Overall, study quality ranged from moderate to high. These findings indicate that preoperative CS is a strong predictor of poor pain-related outcomes following hip and knee arthroplasty, and incorporating CS assessment into preoperative evaluation may support improved risk stratification and the development of personalized perioperative pain management strategies to optimize postoperative outcomes.