Surgery-related predictors of kneeling ability following total knee arthroplasty: a systematic review and meta-analysis

Abstract Purpose Kneeling ability is among the poorest outcomes following total knee arthroplasty (TKA). The purpose of this meta-analysis was to: (1) quantify kneeling ability after TKA; (2) identify surgical approaches and prosthesis designs that improve kneeling ability following TKA; and (3) quantify the effectiveness of these approaches. Methods We performed a systematic review in accordance with the PRISMA guidelines of multiple medical databases. Data relating to demographics, TKA technique, prosthesis design, and kneeling-specific outcomes were extracted. Comparative outcomes data were pooled using a random effects model. Results Thirty-six studies met the eligibility criteria. The proportion of patients able to kneel increased with longer follow-up (36.8% at a minimum of 1 year follow-up versus 47.6% after a minimum of 3 years follow-up, p < 0.001). The odds of kneeling were greater for patients undergoing an anterolateral incision compared with an anteromedial incision (OR 3.0, 95% CI 1.3–6.9, p = 0.02); a transverse incision compared with a longitudinal incision (OR 3.5, 95% CI 1.4–8.7, p = 0.008); and a shorter incision compared with a longer incision (OR 8.5, 95% CI 2.3–30.9, p = 0.001). The odds of kneeling were worse for a mobile prosthesis compared with a fixed platform design (OR 0.3, 95% CI 0.1–0.7, p = 0.005). Conclusion A large majority of patients are unable to kneel following TKA, although the ability to kneel improves over time. This evidence may facilitate preoperative patient counseling. Variations in choice of incision location and length may affect ability to kneel; however, high-quality randomized trials are needed to corroborate our findings.

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Comparative Efficacy of the Different Surgical Approaches in Total Knee Arthroplasty: A Systematic-Review and Network Meta-Analysis

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.09.052 ◽

2020 ◽

Author(s):

Pierre-Alban Bouché ◽

Simon Corsia ◽

Rémy Nizard ◽

Matthieu Resche-Rigon

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Surgical Approaches ◽

Comparative Efficacy ◽

Total Knee

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Is physical rehabilitation superior to no physical rehabilitation following total knee arthroplasty? A systematic review and meta-analysis

10.1101/2020.04.29.20084392 ◽

2020 ◽

Author(s):

Troels Mark-Christensen ◽

Carsten Juhl ◽

Kristian Thorborg ◽

Thomas Bandholm

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Physical Rehabilitation ◽

Optimal Dosage ◽

Eligibility Criteria ◽

Exercise Interventions ◽

Patient Reported ◽

Total Knee

Introduction: Physical rehabilitation is widely used following total knee arthroplasty (TKA), while no consensus has been reached regarding the optimal dosage, frequency and modality. Before a standardized protocol can be established, it is important to investigate the true efficacy for physical rehabilitation following TKA. Objective: To examine if physical rehabilitation is superior to no physical rehabilitation following total knee arthroplasty in terms of patient-reported outcomes for function and pain. Methods: The search strategy was conducted in five databases (MEDLINE, Embase, Cinahl, CENTRAL and SPORTDiscus) with eligibility criteria for inclusion being: Randomised controlled trials comparing patients receiving physical rehabilitation with a group receiving no physical rehabilitation following unilateral TKA. Potential sources of bias were assessed according to the Cochrane Risk of Bias Tool. The Consensus on Exercise Reporting Template (CERT) was used to extract and report exercise interventions from the included trials. Results: Only two of 3254 identified trials fulfilled the eligibility criteria and were included. The two trials were judged as being of moderate to good methodological quality, but lacking in the reporting of their exercise interventions. Difference in outcome measurements and interventions makes between-study comparison inconclusive. Conclusions: No conclusion regarding the superiority of physical rehabilitation to no-intervention following TKA can be drawn from the results of this systematic review. Further research is required to establish the true effectiveness of physical rehabilitation following TKA. Systematic review registration number: PROSPERO 2018 CRD42018094785.

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Kinematically Aligned Total Knee Arthroplasty or Mechanically Aligned Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0038-1632378 ◽

2018 ◽

Vol 31 (10) ◽

pp. 999-1006 ◽

Cited By ~ 19

Author(s):

Juned Ansari ◽

Hemant Pandit ◽

Tsuneari Takahashi

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Tibial Component ◽

Meta Analysis ◽

Clinical Results ◽

Patient Specific ◽

Total Knee

AbstractKinematically aligned total knee arthroplasty (KATKA) was developed to more anatomically align the knee prosthesis to restore the native alignment of the knee and promote physiological kinematics. Even though there are concerns with implant survival, and follow-up at 10 years or more after KATKA has not been reported, there is a negligible incidence of failure of a tibial component at 2 to 9 years. Early clinical results with this technique are encouraging and demonstrate better functional outcomes compared with mechanically aligned TKA (MATKA). The purpose of this study is to perform a systematic review and meta-analysis of the literature to determine whether there are any clinical differences between KATKA and MATKA. The authors conducted a systematic review of the English literature. Five randomized controlled trials (RCTs) which compared clinical outcomes of KATKA and MATKA were finally included. Four RCTs used patient-specific instrument, and one RCT used navigation. Data were extracted and meta-analysis was conducted. KATKA patients had better outcomes: Mean difference between KATKA and MATKA and p-value are presented in brackets after each variable: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (–12.5; p < 0.0001), Oxford Knee Score (OKS) (2.3; p = 0.030), combined Knee Society Score (C-KSS) (13.1; p < 0.0001), Knee Function Score (KFS) (6.4; p = 0.0070), and postoperative range of motion (ROM) (4.1°; p = 0.0010). There was no significant difference concerning the complication rates which needed reoperations or revision surgery (odds ratio, 1.01; p = 0.99). KATKA components had a more femoral valgus (–1.8°; p < 0.0001), more tibial varus (1.2°; p = 0.0001), and more tibial slope (1.2°; p = 0.0001), all being statistically significantly different. Better clinical outcomes were obtained in KATKA and component placement in KATKA is significantly different from that in MATKA. There was no increase of patients with poor clinical results due to implant position especially for varus placement of tibial component. This systematic review of five RCTs suggests that KATKA is of potential alternative method to MATKA since the risk of revision for tibial loosening is negligible compared with MATKA for the same follow-up period.

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Comparison of Long-term Radiographic Outcomes and Rate and Time for Conversion to Total Knee Arthroplasty Between Repair and Meniscectomy for Medial Meniscus Posterior Root Tears: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/03635465211017514 ◽

2021 ◽

pp. 036354652110175

Author(s):

Laura M. Krivicich ◽

Kyle N. Kunze ◽

Kevin C. Parvaresh ◽

Kyleen Jan ◽

Annie DeVinney ◽

...

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Medial Meniscus ◽

Meta Analysis ◽

Posterior Root ◽

Random Effects Models ◽

Total Knee

Background: Previous meta-analyses have demonstrated superior outcomes in patients undergoing arthroscopic repair of medial meniscus posterior root tears (MMPRTs) compared with meniscectomy. However, these analyses have considered only short- or midterm outcomes and low-quality evidence. Purpose: To compare the mid- to long-term rates of radiographic osteoarthritis (OA) between repair and meniscectomy for MMPRT. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, EMBASE, Ovid/MEDLINE, and Cochrane Central Register of Controlled Trials databases were queried for articles evaluating repair and meniscectomy for MMPRT. Articles were eligible if they had a minimum mean 4-year follow-up for radiographic OA or conversion to total knee arthroplasty (TKA) and were at least level 3 evidence. Radiographic OA was assessed using Kellgren-Lawrence (KL) progression. Rates of conversion to TKA and International Knee Documentation Committee (IKDC) scores were also extracted. DerSimonian-Laird binary random-effects models were created to evaluate differences in radiographic OA and TKA conversion rates, with odds ratios (ORs) representing pooled estimates. Continuous random-effects models with standardized mean differences (SMDs) were used to compare postoperative IKDC scores. Results: Repair and meniscectomy cohorts were followed for a mean of 64.8 months and 62.5 months, respectively, for KL progression; and 82.8 months and 73.8 months, respectively, for TKA rates and IKDC scores. Overall, 59 of 144 (41%) patients undergoing surgical intervention for MMPRT demonstrated OA progression; 18 of 82 (22%) who underwent repair for MMPRT exhibited OA progression compared with 41 of 62 (66%) who underwent meniscectomy (OR, 0.17; 95% CI, 0.03-0.83; P = .029). Overall, 30 of 143 (21%) patients converted to TKA; 9.8% (8/82) of patients who underwent repair converted to TKA (range, 47-131 months), while 36% (22/61) who underwent meniscectomy converted to TKA (range, 17.8-101 months) (OR, 0.15; 95% CI, 0.05-0.44; P < .001). No significant differences between postoperative IKDC scores were observed (SMD, 0.51; 95% CI, -0.02 to 1.05; P = .06). Conclusion: Medial meniscus posterior root repair results in significantly lower rates of radiographic OA progression and conversion to TKA at >60-month follow-up. On the basis of these findings, we recommend consideration of repair of MMPRTs when degenerative changes are not severe, as it can yield improved outcomes.

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