Perioperative Anxiety in Total Knee Arthroplasty: Clinical Consequences, Potential Mechanisms, and Management—A Narrative Review
- 1Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
- 2Yan’an Medical College, Yan’an University, Yan’an 716000, China
Abstract
Total knee arthroplasty (TKA) treats end-stage knee osteoarthritis, yet some patients report persistent pain, incomplete recovery, or dissatisfaction. Perioperative anxiety is a potentially modifiable factor associated with poorer outcomes. This narrative review examines its clinical consequences, mechanisms, and management in TKA. PubMed, Embase, Web of Science, and the China National Knowledge Infrastructure were searched without date or language restrictions through 25 September 2026. Evidence was stratified by anxiety-related selection at enrollment: studies of anxiety-selected patients provided direct evidence, whereas studies without such selection provided indirect evidence, regardless of whether anxiety was a primary, secondary, or exploratory outcome. Sixty studies underwent formal risk-of-bias appraisal. Higher anxiety was associated with greater postoperative pain and analgesic requirements and poorer patient-reported recovery and satisfaction, whereas findings for persistent pain and long-term function were less consistent. Proposed pathways include catastrophizing, kinesiophobia, reduced self-efficacy, pain sensitization, and stress-related biological processes. Pharmacological, psychoeducational, cognitive behavioral, digital, and adjunctive interventions may reduce anxiety, but direct evidence remains limited, and improvements do not consistently translate into less pain or opioid use, better function, or higher satisfaction. Anxiety may be considered in preoperative risk assessment, while standardized assessment and higher-quality trials remain needed.
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BibTeX
@article{zhang2026perioperative,
title = {{Perioperative Anxiety in Total Knee Arthroplasty: Clinical Consequences, Potential Mechanisms, and Management—A Narrative Review}},
author = {Honghua Zhang and Xiang Ji and Xiangxiang Sun and Zichao He and Haotian Yi and Yanling Yang and Huanli Bao and Yuanchi Huang and Jianbing Ma},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208140},
url = {https://www.mdpi.com/2077-0383/15/20/8140},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Perioperative Anxiety in Total Knee Arthroplasty: Clinical Consequences, Potential Mechanisms, and Management—A Narrative Review
AU - Honghua Zhang
AU - Xiang Ji
AU - Xiangxiang Sun
AU - Zichao He
AU - Haotian Yi
AU - Yanling Yang
AU - Huanli Bao
AU - Yuanchi Huang
AU - Jianbing Ma
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208140
UR - https://www.mdpi.com/2077-0383/15/20/8140
AB - Total knee arthroplasty (TKA) treats end-stage knee osteoarthritis, yet some patients report persistent pain, incomplete recovery, or dissatisfaction. Perioperative anxiety is a potentially modifiable factor associated with poorer outcomes. This narrative review examines its clinical consequences, mechanisms, and management in TKA. PubMed, Embase, Web of Science, and the China National Knowledge Infrastructure were searched without date or language restrictions through 25 September 2026. Evidence was stratified by anxiety-related selection at enrollment: studies of anxiety-selected patients provided direct evidence, whereas studies without such selection provided indirect evidence, regardless of whether anxiety was a primary, secondary, or exploratory outcome. Sixty studies underwent formal risk-of-bias appraisal. Higher anxiety was associated with greater postoperative pain and analgesic requirements and poorer patient-reported recovery and satisfaction, whereas findings for persistent pain and long-term function were less consistent. Proposed pathways include catastrophizing, kinesiophobia, reduced self-efficacy, pain sensitization, and stress-related biological processes. Pharmacological, psychoeducational, cognitive behavioral, digital, and adjunctive interventions may reduce anxiety, but direct evidence remains limited, and improvements do not consistently translate into less pain or opioid use, better function, or higher satisfaction. Anxiety may be considered in preoperative risk assessment, while standardized assessment and higher-quality trials remain needed.
SN - 2077-0383
ER -