Dias S, Ashworth S, McGonagle S, Divall P, Dias J. Diagnosis and management of neuropathic pain post-total knee replacement: A systematic review. World J Orthop 2026; 17(6): 119956 [DOI: 10.5312/wjo.v17.i6.119956]
Corresponding Author of This Article
Simon Dias, MBBS, MRCP, Department of Medicine, Sheffield Teaching Hospitals, Herries Road, Sheffield S5 7AU, United Kingdom. simon.dias2@nhs.net
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Orthopedics
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Dias S, Ashworth S, McGonagle S, Divall P, Dias J. Diagnosis and management of neuropathic pain post-total knee replacement: A systematic review. World J Orthop 2026; 17(6): 119956 [DOI: 10.5312/wjo.v17.i6.119956]
World J Orthop. Jun 18, 2026; 17(6): 119956 Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.119956
Diagnosis and management of neuropathic pain post-total knee replacement: A systematic review
Simon Dias, Samantha Ashworth, Sarah McGonagle, Pip Divall, Joseph Dias
Simon Dias, Sarah McGonagle, Department of Medicine, Sheffield Teaching Hospitals, Sheffield S5 7AU, United Kingdom
Samantha Ashworth, Department of Anaesthesia, East Suffolk and North Essex NHS Foundation Trust, Ipswich IP4 5PD, Suffolk, United Kingdom
Pip Divall, Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
Joseph Dias, Department of Trauma & Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
Author contributions: Dias S, Ashworth S, McGonagle S, Divall P, and Dias J wrote and edited the paper; Dias S, Ashworth S, and McGonagle S collected data, attended regular conflict resolution meetings and cleaned the data, confirmed and checked quotes, extracted the final data and generated the tables; Dias S and Dias J designed the research questions, method and analysis, prepared all tables and generated the figures, and all managed it on weekly meetings. All authors read the final paper and suggested corrections.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Simon Dias, MBBS, MRCP, Department of Medicine, Sheffield Teaching Hospitals, Herries Road, Sheffield S5 7AU, United Kingdom. simon.dias2@nhs.net
Received: February 11, 2026 Revised: March 10, 2026 Accepted: May 9, 2026 Published online: June 18, 2026 Processing time: 126 Days and 16.5 Hours
Abstract
BACKGROUND
Neuropathic pain is common after total knee replacement (TKR), with incidence between 5% and 50%, but its identification, grading and treatment effectiveness remain unclear. The burden is high as the prevalence of TKR is 137 TKR/100000 across 33 countries (2019, Organisation for Economic Co-operation and Development).
AIM
To identify effective diagnosis and management of neuropathic pain after TKR the literature was systematically reviewed.
METHODS
We followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and registered in International Prospective Register of Systematic Reviews (No. CRD42021273288). Seven databases (MEDLINE, Cochrane Central, EMBASE, CINAHL, Emcare, Clinicaltrials.gov and World Health Organization International Clinical Trials Registry) were searched on Augst 19, 2021 (updated December 9, 2024) for studies reporting outcomes of treatment of neuropathic pain after TKR. The primary outcome was pain severity at 6-12 months. Papers were independently screened by three reviewers and risk of bias assessed. Data on population, interventions, duration of follow up, attrition and outcomes were extracted.
RESULTS
Of 7025 publications, 38 met the inclusion criteria. Seven studies were identified reporting different treatments and two randomized controlled studies were of good quality and low bias. Only two report a Visual Analogue Scale standardized mean difference of > 2 points at 6-12 months. The data on proportions with neuropathic pain could not be extracted in 5 of 7 papers. Data did not permit meta-analysis so synthesis without meta-analysis recommendations in reporting outcomes were followed. Three papers addressed interventions on the peripheral sensory nerve reporting improvement (hydro-dissection, resection or resisting of peripheral nerve, nerve block and neurectomy). Two studies investigated modifying the dorsal root ganglia with either radiofrequency ablation or transcutaneous electrical nerve stimulation. Two studies addressed modifying central sensitization; one reporting benefit.
CONCLUSION
This review identifies a considerable evidence gap for treatment effectiveness of post-TKR neuropathic pain. Studies are heterogenous in case definition, severity assessment and outcomes reported, which precludes treatment recommendations. A possible management pathway is outlined but requires validation. Future studies should report proportions with neuropathic pain and pain severity to 1-2 years post-treatment.
Core Tip: Total knee replacements (TKRs) are a common procedure and the incidence of neuropathic pain post-TKR has been reported as up to 50%. The literature on diagnosis and management of neuropathic pain post-TKR was systematically reviewed. Seven eligible studies had different case definitions, severity assessment and outcomes reported. Current evidence does not support clear treatment recommendations for these patients. A possible logical pathway based on the current literature is outlined, but needs evidence of effectiveness for each step.
