Sex differences in preoperative pain intensity among patients undergoing total knee arthroplasty: A propensity score–matched cross-sectional study

IF 9 2区医学 Q1 ORTHOPEDICS

Osteoarthritis and Cartilage Pub Date : 2026-05-01 Epub Date: 2025-12-19 DOI:10.1016/j.joca.2025.12.009

So Tanaka , Yuta Tomooka , Akira Mibu , Ryota Imai , Hirofumi Yamashita , Masahiro Manfuku , Keiko Yamada , Masami Tokunaga , Takaaki Yoshimoto , Takahiro Ushida , Tomohiko Nishigami

{"title":"Sex differences in preoperative pain intensity among patients undergoing total knee arthroplasty: A propensity score–matched cross-sectional study","authors":"So Tanaka , Yuta Tomooka , Akira Mibu , Ryota Imai , Hirofumi Yamashita , Masahiro Manfuku , Keiko Yamada , Masami Tokunaga , Takaaki Yoshimoto , Takahiro Ushida , Tomohiko Nishigami","doi":"10.1016/j.joca.2025.12.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Although sex differences in knee osteoarthritis (OA) pain are well documented, previous studies have not adequately adjusted for structural and inflammatory confounders. Clarifying whether preoperative sex differences in pain persist after such adjustment is clinically important in advanced OA because it may influence surgical decision-making, preoperative counselling, and strategies to prevent persistent postoperative pain.</div></div><div><h3>Objective</h3><div>To compare preoperative pain intensity, pain sensitivity, psychosocial characteristics, and physical function between women and men with advanced knee OA using propensity score–matched analysis.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, 120 patients (60 women and 60 men) with advanced knee OA were propensity score–matched 1:1 on age, body mass index, Kellgren–Lawrence grade, C-reactive protein, synovitis, and bone marrow lesions. Primary outcomes were pain intensity at rest and during movement. Secondary outcomes were central sensitization-related symptoms (CSI-9), pressure pain thresholds (PPTs), psychosocial measures, and physical function.</div></div><div><h3>Results</h3><div>After matching, women reported significantly greater resting pain (23.3 ± 22.3 vs. 11.0 ± 15.2; mean difference = 12.3 mm, 95% CI: 5.1–19.5) but similar movement pain (47.2 ± 25.0 vs. 45.3 ± 24.6; mean difference = 1.9 mm, 95% CI: −7.4 to 11.2). They also showed higher CSI-9 scores, lower PPTs at the knee and forearm, and poorer physical function, with no significant differences in psychosocial measures.</div></div><div><h3>Conclusion</h3><div>Women with advanced knee OA awaiting surgery showed greater pain sensitivity and human-assumed central sensitization than men, independent of structural and inflammatory factors. This supports sex-specific mechanisms and underscores individualized pain assessment and rehabilitation.</div></div>","PeriodicalId":19654,"journal":{"name":"Osteoarthritis and Cartilage","volume":"34 5","pages":"Pages 707-715"},"PeriodicalIF":9.0000,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Osteoarthritis and Cartilage","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S106345842501249X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/12/19 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Although sex differences in knee osteoarthritis (OA) pain are well documented, previous studies have not adequately adjusted for structural and inflammatory confounders. Clarifying whether preoperative sex differences in pain persist after such adjustment is clinically important in advanced OA because it may influence surgical decision-making, preoperative counselling, and strategies to prevent persistent postoperative pain.

Objective

To compare preoperative pain intensity, pain sensitivity, psychosocial characteristics, and physical function between women and men with advanced knee OA using propensity score–matched analysis.

Methods

In this cross-sectional study, 120 patients (60 women and 60 men) with advanced knee OA were propensity score–matched 1:1 on age, body mass index, Kellgren–Lawrence grade, C-reactive protein, synovitis, and bone marrow lesions. Primary outcomes were pain intensity at rest and during movement. Secondary outcomes were central sensitization-related symptoms (CSI-9), pressure pain thresholds (PPTs), psychosocial measures, and physical function.

Results

After matching, women reported significantly greater resting pain (23.3 ± 22.3 vs. 11.0 ± 15.2; mean difference = 12.3 mm, 95% CI: 5.1–19.5) but similar movement pain (47.2 ± 25.0 vs. 45.3 ± 24.6; mean difference = 1.9 mm, 95% CI: −7.4 to 11.2). They also showed higher CSI-9 scores, lower PPTs at the knee and forearm, and poorer physical function, with no significant differences in psychosocial measures.

Conclusion

Women with advanced knee OA awaiting surgery showed greater pain sensitivity and human-assumed central sensitization than men, independent of structural and inflammatory factors. This supports sex-specific mechanisms and underscores individualized pain assessment and rehabilitation.

查看原文本刊更多论文

全膝关节置换术患者术前疼痛强度的性别差异：倾向评分匹配的横断面研究

背景：虽然膝关节骨关节炎（OA）疼痛的性别差异有充分的文献记载，但以前的研究并没有充分调整结构和炎症混杂因素。明确这种调整后术前疼痛的性别差异是否持续存在对晚期OA具有重要的临床意义，因为它可能影响手术决策、术前咨询和预防术后持续疼痛的策略。目的采用倾向评分匹配分析比较晚期膝关节OA患者术前疼痛强度、疼痛敏感性、心理社会特征和身体功能。方法在这项横断研究中，120例晚期膝关节OA患者（60名女性和60名男性）在年龄、体重指数、Kellgren-Lawrence分级、c反应蛋白、滑膜炎和骨髓病变方面以1:1的倾向评分匹配。主要结局是休息和运动时的疼痛强度。次要结局是中枢致敏相关症状（CSI-9）、压痛阈（PPTs）、社会心理测量和身体功能。结果匹配后，女性报告的静息疼痛明显加重（23.3±22.3 vs. 11.0±15.2；平均差值= 12.3 mm, 95% CI: 5.1-19.5），但运动疼痛相似（47.2±25.0 vs. 45.3±24.6；平均差值= 1.9 mm, 95% CI:−7.4 - 11.2）。他们还表现出更高的CSI-9评分，膝盖和前臂的PPTs较低，身体功能较差，在社会心理测量方面没有显著差异。结论：等待手术的晚期膝关节OA患者的疼痛敏感性和人为中枢致敏性高于男性，与结构和炎症因素无关。这支持了性别特异性机制，并强调了个性化的疼痛评估和康复。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Osteoarthritis and Cartilage 医学-风湿病学

CiteScore

11.70

自引率

7.10%

发文量

802

审稿时长

52 days

期刊介绍： Osteoarthritis and Cartilage is the official journal of the Osteoarthritis Research Society International. It is an international, multidisciplinary journal that disseminates information for the many kinds of specialists and practitioners concerned with osteoarthritis.