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已发表论文
膝关节置换术后神经病理性疼痛患病率及基于列线图的预测模型
Authors Xin Y, Wang C, Li J , Fang X, Huang Z, Bai G, Li W, Zhang W , Zhang C
Received 4 September 2025
Accepted for publication 18 January 2026
Published 29 January 2026 Volume 2026:19 565227
DOI https://doi.org/10.2147/JPR.S565227
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor King Hei Stanley Lam
Yishan Xin,1– 4 Chenwei Wang,5 Juncheng Li,1– 4 Xinyu Fang,1– 4 Zida Huang,1– 4 Guochang Bai,1– 4 Wenbo Li,1– 4 Wenming Zhang,1– 4 Chaofan Zhang1– 4
1Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China; 2Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People’s Republic of China; 3Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China; 4Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, 350005, People’s Republic of China; 5School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
Correspondence: Chaofan Zhang, Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350001, People’s Republic of China, Tel +860591-87982113, Email drcfzhang@gmail.com Wenming Zhang, Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350001, People’s Republic of China, Tel +860591-87982113, Email zhangwm0591@fjmu.edu.cn
Background: Neuropathic pain (NP) following knee arthroplasty significantly impairs patient quality of life, yet current research lacks objective predictors and predictive models. This study aimed to identify postoperative NP associated factors and develop a nomogram prediction model.
Methods: We enrolled 128 patients undergoing primary unilateral knee arthroplasty (February 2023–August 2024) with 6– 24 month follow-up. NP was assessed using PainDETECT (PDQ) and DN4 scales; pain-related quality of life was evaluated via the Oxford Knee Score pain subscale (OKS-PS). Clinical records were systematically reviewed. Variables were screened using univariate logistic regression, optimized via LASSO regression, and incorporated into a multivariate logistic regression nomogram, followed by validation analyses.
Results: NP incidence was 14.06% (18/128). OKS-PS confirmed a significant association between postoperative NP and reduced quality of life. The nomogram identified female sex, decreased preoperative range of motion (ROM), greater preoperative mechanical axis angles (pMAA) difference, and higher postoperative C-Reactive protein (CRP) as factors significantly associated with NP. Bootstrap validation yielded an AUC of 0.764 (95% CI: 0.760– 0.770), sensitivity 0.707 (0.694– 0.718), and specificity 0.737 (0.724– 0.747). 10-fold cross-validation showed comparable results: AUC 0.813 (0.721– 0.906), sensitivity 0.778 (0.5– 0.938), specificity 0.764 (0.676– 0.833). Calibration curves indicated agreement (MAE=0.037), and DCA demonstrated strong clinical utility across threshold probabilities of 0.003– 0.391.
Conclusion: Postoperative NP was significantly associated with female sex, reduced preoperative ROM, increased pMAA difference, and elevated postoperative CRP. The validated nomogram showed good predictive performance, establishing a reliable tool for early identification and risk assessment of post-arthroplasty NP.
Keywords: neuropathic pain, knee arthroplasty, associated factors, nomogram, prevalence
1Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China; 2Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, People’s Republic of China; 3Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China; 4Fujian Orthopaedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, 350005, People’s Republic of China; 5School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
Correspondence: Chaofan Zhang, Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350001, People’s Republic of China, Tel +860591-87982113, Email drcfzhang@gmail.com Wenming Zhang, Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350001, People’s Republic of China, Tel +860591-87982113, Email zhangwm0591@fjmu.edu.cn
Background: Neuropathic pain (NP) following knee arthroplasty significantly impairs patient quality of life, yet current research lacks objective predictors and predictive models. This study aimed to identify postoperative NP associated factors and develop a nomogram prediction model.
Methods: We enrolled 128 patients undergoing primary unilateral knee arthroplasty (February 2023–August 2024) with 6– 24 month follow-up. NP was assessed using PainDETECT (PDQ) and DN4 scales; pain-related quality of life was evaluated via the Oxford Knee Score pain subscale (OKS-PS). Clinical records were systematically reviewed. Variables were screened using univariate logistic regression, optimized via LASSO regression, and incorporated into a multivariate logistic regression nomogram, followed by validation analyses.
Results: NP incidence was 14.06% (18/128). OKS-PS confirmed a significant association between postoperative NP and reduced quality of life. The nomogram identified female sex, decreased preoperative range of motion (ROM), greater preoperative mechanical axis angles (pMAA) difference, and higher postoperative C-Reactive protein (CRP) as factors significantly associated with NP. Bootstrap validation yielded an AUC of 0.764 (95% CI: 0.760– 0.770), sensitivity 0.707 (0.694– 0.718), and specificity 0.737 (0.724– 0.747). 10-fold cross-validation showed comparable results: AUC 0.813 (0.721– 0.906), sensitivity 0.778 (0.5– 0.938), specificity 0.764 (0.676– 0.833). Calibration curves indicated agreement (MAE=0.037), and DCA demonstrated strong clinical utility across threshold probabilities of 0.003– 0.391.
Conclusion: Postoperative NP was significantly associated with female sex, reduced preoperative ROM, increased pMAA difference, and elevated postoperative CRP. The validated nomogram showed good predictive performance, establishing a reliable tool for early identification and risk assessment of post-arthroplasty NP.
Keywords: neuropathic pain, knee arthroplasty, associated factors, nomogram, prevalence