title: Pain after knee arthroplasty: an unresolved issue.
abstract: OBJECTIVE
  Despite the recent advances in the understanding of pain mechanisms and the introduction of new drugs and new techniques in the postoperative management, pain after total knee arthroplasty (TKA) is still an unresolved issue. It affects the quality of life and rehabilitation of an important percentage of patients undergoing TKA. The aim of this narrative review was to give an overview on pain mechanisms and multimodal pain management.
  
  
  METHODS
  A review of all peer-reviewed articles on pain after knee arthroplasty was performed by two reviewers. Recent articles on incisional pain mechanisms were included because of their importance in the understanding of postsurgical pain. Search was performed in Pubmed, Cochrane and Google Scholar data bases.
  
  
  RESULTS
  Postsurgical pain mechanisms are based on both local and systemic inflammatory reactions. Peri-operative pain management starts with the anaesthetic technique and resides on a multimodal analgesia regimen. New concepts, drugs and techniques have shown their efficacy in reducing the severity of acute postoperative pain and the risk of developing chronic pain after TKA.
  
  
  CONCLUSIONS
  This narrative review offers a clear overview of pain mechanism after knee arthroplasty and an understanding on how multimodal pain management can reduce the intensity and duration of pain after knee arthroplasty.
authors.affiliation: Department of Anesthesiology, Cliniques Universitaires Saint Luc, Av. Hippocrate 10, 1200, Brussels, Belgium.
authors.forename: Irina
authors.initials: I
authors.lastname: Grosu
authors.forename: Patricia
authors.initials: P
authors.lastname: Lavand'homme
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Thienpont
mesh_terms: D059787:Acute Pain; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D059350:Chronic Pain; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D007717:Knee / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D059408:Pain Management; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*