Predictors of chronic pain and level of physical function in total knee arthroplasty: a protocol for a systematic review and meta-analysis

IntroductionOne in five patients undergoing total knee arthroplasty (TKA) experience unchanged or worse pain and physical function 1 year after surgery. Identifying risk factors for unfavourable outcomes is necessary to develop tailored interventions to minimise risk. There is a need to review more current literature with updated methodology that addresses the limitations of earlier systematic reviews and meta-analyses. We present a Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols compliant protocol for a systematic review and meta-analysis of predictors of chronic pain and impaired function after TKA.Methods and analysisThis review will include prospective longitudinal observational studies, or randomised trials (including cluster and crossover designs) that report arm-wise predictors of chronic postsurgical pain or impaired physical function at 3 months, 6 months or 12 months. A comprehensive literature search of studies published between 2000 and 2019 will be performed in Medline, Embase, CINAHL, Cochrane Library and PEDro. Blinded assessment with consensus agreement will be applied for inclusion of studies, data extraction and assessment of bias risk (Quality in Prognosis Studies tool). The co-primary outcomes, pain and impaired function, at 12 months after TKA will be analysed separately. Estimates of association between each outcome and any preoperative or intraoperative factor that may predict chronic pain or impaired physical function will be extracted from the included studies, where possible. For randomised studies, results will only be extracted from TKA arms (or the first period of crossover trials). Estimates of association from the primary evidence will be synthesised narratively, and quantitatively using multivariate meta-analysis to provide ‘pooled’ estimates of association. Subgroup and sensitivity analyses will be performed. Certainty of evidence for each predictor will be derived from the Grading of Recommendations Assessment, Development and Evaluation framework.Ethics and disseminationNo ethical issues are associated with this project. The results from this review will be published in peer-reviewed journals and presented at international conferences.PROSPERO registration numberCRD42018079069.

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Impact of Smoking on the Incidence and Postoperative Complications of Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Cohort Studies

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2021.6538 ◽

2021 ◽

Author(s):

Yuqi He ◽

Mohamed Omar ◽

Xiaoyuan Feng ◽

Claudia Neunaber ◽

Michael Jagodzinski

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Cohort Studies ◽

Knee Arthroplasty ◽

Surgical Complications ◽

Meta Analysis ◽

Cochrane Library ◽

Total Knee ◽

The Impact

Osteoarthritis and rheumatoid arthritis are the most ubiquitous joint disorders which cause tremendous loss of life quality and impose an economic burden on society. At present, the treatment options for these two diseases comprise non-operative and surgical treatments, amongst those total knee arthroplasties (TKA). Various studies have recognized smoking as a significant risk factor for postoperative complications. Therefore, the purpose of this study was to examine the impact of smoking on the incidence and postoperative complications after a total knee arthroplasty by a systematic review and meta-analysis. The research was performed using PUBMED, Cochrane Library and EMBASE, extracting data from thirteen suitable studies and incorporating 2,109,482 patients. Cohort studies evaluating the impact of smoking on TKA with sufficient data were included for the study, and cohort studies without a proper control group and complete data were excluded. A fixed-effects or random-effects model was used to measure the pooled risk ratio (RR) or hazard ratio (HR) with 95% confidence interval (CI). Compared to non-smokers, smokers had a significantly lower incidence of TKA (p<0.01). However, smokers had a higher incidence of total complications (p=0.01), surgical complications (p<0.01), pneumonia (p<0.01) and revision surgery (p=0.01). No significant difference in the risk of blood transfusion (p=0.42), deep vein thrombosis (p=0.31), pulmonary embolism (p=0.34), urinary tract infection (p=0.46) or mortality (p=0.39) was found between smokers and non-smokers. In conclusion, the study indicated that tobacco has two diametrically opposite effects on TKA patients: 1. Tobacco increases the incidence of surgical complications, pneumonia and revision after TKA; 2. It decreases the overall risk of being a candidate for TKA.

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Effects of motor imagery on strength, range of motion, physical function, and pain intensity in patients with total knee arthroplasty: A systematic review and meta-analysis

Brazilian Journal of Physical Therapy ◽

10.1016/j.bjpt.2021.11.001 ◽

2021 ◽

Author(s):

Raúl Ferrer-Peña ◽

Ferran Cuenca-Martínez ◽

Mario Romero-Palau ◽

Luis Miguel Flores-Román ◽

Pablo Arce-Vázquez ◽

...

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Pain Intensity ◽

Range Of Motion ◽

Physical Function ◽

Motor Imagery ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Total Knee

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A commentary on “The optimal dosage, route and timing of glucocorticoids administration for improving knee function, pain and inflammation in primary total knee arthroplasty: A systematic review and network meta-analysis of 34 randomized trials” [Int. J. Surg. 82 (2020 Oct) 182–191]

International Journal of Surgery ◽

10.1016/j.ijsu.2021.01.014 ◽

2021 ◽

Vol 87 ◽

pp. 105888

Author(s):

Shijie Lin ◽

Baojin Wu ◽

Yufei Li

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Randomized Trials ◽

Meta Analysis ◽

Primary Total Knee Arthroplasty ◽

Knee Function ◽

Optimal Dosage ◽

Total Knee ◽

Primary Total Knee

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The role of perioperative intravenous low-dose dexamethasone in rapid recovery after total knee arthroplasty: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060521998220 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199822

Author(s):

Youguang Zhuo ◽

Rongguo Yu ◽

Chunling Wu ◽

Yuting Huang ◽

Jie Ye ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Low Dose ◽

Meta Analysis ◽

Postoperative Nausea And Vomiting ◽

Opioid Consumption ◽

Cochrane Library ◽

China National Knowledge Infrastructure ◽

Postoperative Rehabilitation ◽

Total Knee

Purpose The purpose of this meta-analysis was to evaluate the overall safety and effectiveness of perioperative intravenous dexamethasone to facilitate postoperative rehabilitation in patients after total knee arthroplasty (TKA). Methods A comprehensive literature search was performed using the Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for relevant randomized controlled trials (RCTs) from inception to 2020. Methodological quality of the trials was assessed using the Cochrane Risk of Bias Tool, and the relevant data were extracted using a predefined data extraction form. Results Ten RCTs with 1100 knees were included. Our study showed a significant reduction in pain using a postoperative pain visual analog scale (VAS) at 24 hours and 48 hours, total opioid consumption at 24 hours and 48 hours, postoperative nausea and vomiting (PONV), active range of motion (ROM) limitation, and passive ROM limitation at 72 hours in dexamethasone-treated groups compared with controls. Conclusion Intravenous low-dose dexamethasone is potentially useful in the perioperative setting for reducing postsurgical immediate ROM limitations, pain, opioid consumption, and PONV. There are no data that directly attribute an increase in postoperative complications to intravenous dexamethasone. More high-quality studies are necessary to draw these conclusions.

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