Objective To investigate the level of pain catastrophe in total knee arthroplasty patients and its influencing factors, so as to provide reference for developing targeted intervention. Methods Totally 356 total knee arthroplasty patients from 5 tertiary general hospitals in northern part of Henan province were selected by convenience sampling, then they were investigated using the general information questionnaire, pain catastrophizing scale, hospital for special surgery knee score and positive and negative affect scale. Results The total pain catastrophe score of patients undergoing total knee arthroplasty was (31.01±7.05), and 74(20.79%) patients scored 38 or more, which reached the level of pain catastrophe. Multiple linear regression analysis showed that, knee function, positive emotions, occupation and age were the main influencing factors of pain catastrophe (P＜0.01 for all). Conclusion Patients undergoing total knee arthroplasty suffer from a high level of pain catastrophe, those farmer and elderly patients with a lower knee function and positive emotion scores are more likely to experience pain catastrophe. Medical staff should develop targeted intervention according to the major influencing factors, so as to reduce pain catastrophe for the patients.