Functional gain following knee replacement in patients aged 75 and older: a prospective follow-up study

Boehme

Geriatr Orthop Surg Rehabil

et al. 2018

Introduction:To evaluate the body of evidence on the predictive value of preoperative cognitive impairment on in-hospital, short-term, and midterm postoperative outcomes for elderly patients undergoing total knee arthroplasty (TKA).Significance:With an aging population, an increasing percentage of the U.S. patient population will be living with cognitive impairment. There is currently no systematic review that assesses postoperative outcomes of patients with mild cognitive impairment (MCI) or preexisting diagnosis of dementia while undergoing elective primary TKA.Results:A database search between January 1, 1997, and November 1, 2017 in EMBASE, MEDLINE, and PubMed was conducted to identify articles that compared postoperative outcomes after TKA between patients aged 60 years with and without cognitive impairment. Cognitive impairment included preexisting diagnosis of dementia or MCI identified during preoperative assessment. Eligible articles were selected using dual reviewer and third-party arbitrator. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A total of 6163 abstracts were screened. Only 11 full text articles met inclusion criteria, including 1 case–control, 5 prospective cohort, and 5 retrospective cohort studies. Two studies were of poor quality. Overall, there is moderate strength of evidence for increased risk of postoperative delirium, increased length of stay, and discharge to health-care facility among patients with preoperative MCI or preexisting dementia. The body of evidence is weak for other outcomes of interest including mortality, functionality and complications while in-hospital and in the short- and midterm.Conclusion:This review highlights the need for additional good quality studies to provide more information about MCI and dementia as risk factors in primary TKA.

Section: Resultsmentioning

confidence: 92%

Postoperative Outcomes in Primary Total Knee Arthroplasty Patients With Preexisting Cognitive Impairment: A Systematic Review

Boehme

Geriatr Orthop Surg Rehabil

et al. 2018

Knee Surg Sports Traumatol Arthrosc

“…Twenty studies relied solely on the KL grading system [3, 14, 18, 22, 25, 27–30, 32, 34–39, 41, 42] or a modification of it [5, 15]. Five studies relied on a combination of KL grades with either joint space narrowing or Ahlbaeck score [8, 13, 21, 33, 40]. Two studies relied only on joint space narrowing [19, 23] and two studies relied only on the Ahlbaeck classification or a modification of it [4, 9].…”

Section: Resultsmentioning

confidence: 99%

“…The Visual Analog Scale (VAS) was used in six studies [21, 25, 29, 30, 33, 42]. 23 studies specifically reported on function [3–5, 9, 13, 14, 18, 19, 22, 25, 27, 28, 30, 33, 36–42]. 22 studies reported on pain [4, 5, 9, 13, 14, 19, 25, 27, 28, 30, 33, 36–39, 41, 42].…”

Section: Resultsmentioning

confidence: 99%

“…Key results are summarized in Table 1. Overall, 24 studies (82.7%) found a significant association between mild or moderate radiographic imaging and poor outcomes in at least one measured category [3, 5, 8, 9, 14, 18, 19, 21–23, 25, 27, 29, 30, 33–36, 38–40, 42], four studies found no such association [4, 28, 37, 41], and one was inconclusive based on presented data [13]. 16 out of 23 (69.6%) studies reported on function, 16 out of 22 (72.7%) studies reported on pain, and seven out of 11 (63.6%) studies that reported on satisfaction found a significant association between mild radiographic OA and poor results.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Mild radiographic osteoarthritis is associated with increased pain and dissatisfaction following total knee arthroplasty when compared with severe osteoarthritis: a systematic review and meta-analysis

Shohat

Heller

Sudya

et al. 2021

PurposeThe association between severity of radiographic osteoarthritis with patient pain, function, and satisfaction following total knee arthroplasty has been disputed. The discrepancies in current literature prompt us to further examine this association in a systematic review and meta-analysis. Methods The OVID-Medline, Embase, and Web of Science databases were searched from their inception up to Mar 2020. The main independent variable was osteoarthritis severity as deined by preoperative radiographs. The outcomes measured were pain, function and satisfaction following total knee arthroplasty. A minimum of three studies assessing the same patient-reported outcome measures were included in the meta-analysis, as well as those separating patients by chronic pain or dissatisfaction. Results 29 studies were included in this study. Signiicant heterogeneity was seen between radiographic evaluation and reported outcomes. Patients with only mild radiographic osteoarthritis were more likely to sufer from chronic pain (odds ratio = 2.45, 95% CI = 1.80-3.34, p < 0.001) and dissatisfaction (odds ratio = 2.43, 95% CI = 1.79-3.31, p < 0.001) compared to patients with severe osteoarthritis. A signiicant association was found between mild radiographic severity and lower total Western Ontario and McMaster Universities Osteoarthritis scores (95% CI = − 0.37-0.06, p = 0.006) as well as Knee Society Scores (CI: − 0.54-0.16, p < 0.001). Conclusion Patients with mild radiographic osteoarthritis are anticipated to gain less from total knee arthroplasty compared to those with severe osteoarthritis. They are also at risk for chronic pain and dissatisfaction and should be consulted about this risk prior to surgery. Level of evidence III.

International Journal of Rehabilitation Research

“…This indicated that patients with a poorer functional score at baseline often derive the most gain in physical function [17]. Furthermore, patients with severe osteoarthritis following TKA have been observed to exhibit greater functional gain even if their final ability was low [27]. Here, we used the M-FIM score for the assessment of rehabilitation effectiveness, which is designed to overcome the ceiling effect of disability measures.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting short-term functional gain following total knee arthroplasty in patients aged from 75 years at a postacute rehabilitation setting

Kawaguchi

Kuwakado

Ohtsuka

et al. 2022

The intensive rehabilitation of older patients after total knee arthroplasty (TKA) is vital for short-term improvement in mobility and daily living activities. We aimed to investigate the effectiveness of multidisciplinary rehabilitation and assess the early postoperative predictors that are associated with functional gain in TKA patients aged from 75 years in a postacute care setting. This study included 190 patients following primary TKA who were admitted at the postacute rehabilitation hospital. The main outcome measures were the motor component of functional independence measure (M-FIM), M-FIM effectiveness, numerical rating scale, knee extension strength and range of motion, 10-m walk test, Berg balance scale (BBS), and mini-mental state examination (MMSE). The functional gain between patient age groups of ≥75 (n = 105) and <75 (n = 85) years were compared. Although patients aged ≥75 years showed lower improvement in BBS score compared with <75 years, the M-FIM gains and other physical functions were similar in both age groups. In multivariate analysis, the results for M-FIM at admission (β: −0.703; P = 0.001), BBS (β: 0.342; P = 0.032) and MMSE (β: 0.446; P = 0.021) were independently associated with functional gain in the patients following TKA aged ≥75 years. Multidisciplinary inpatient rehabilitation was beneficial for basic functional gain except for improvement in balance ability in patients after TKA aged ≥75 years. Functional level, balance ability and cognitive status in the early postoperative period can be useful predictors for short-term functional gain in the postacute care phase.