Patient Reported Kneeling Ability in Fixed and Mobile Bearing Knee Arthroplasty

Artz, Neil; Hassaballa, M; Robinson, James R.; Newman, John H.; Porteous, A; Murray, James R. D.

doi:10.1016/j.arth.2015.06.063

Cited by 26 publications

(27 citation statements)

References 24 publications

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“…Data from one study95 could be included in group 2, which showed a mean difference of −5.00 degrees (−7.28 to −2.72). Data from 13 cohort studies15 54 85 86 87 90 91 95 96 99 104 106 111 in the group 3 analysis showed an overall mean difference of −8.71 degrees (−11.77 to −5.64).…”

Section: Resultsmentioning

confidence: 97%

“…No studies were eligible for inclusion that presented data on kneeling ability in groups 1 or 2. In group 3, the two cohort studies included85 87 showed a risk ratio of 0.53 (95% confidence interval 0.28 to 1.01).…”

Section: Resultsmentioning

confidence: 98%

“…A further 36 cohort studies were included in group 3. Of these studies including data comparisons between UKAs and TKAs,15 31 82 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 only five included data specifically in patients with anteromedial osteoarthritis 1585 99 103 111 Again, we saw some crossover in the data presented from the same unit in multiple papers, but the maximum number of implants was 26 418.…”

Section: Resultsmentioning

confidence: 99%

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Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Wilson

Middleton

Abram

et al. 2019

BMJ

216

206

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Objective To present a clear and comprehensive summary of the published data on unicompartmental knee replacement (UKA) or total knee replacement (TKA), comparing domains of outcome that have been shown to be important to patients and clinicians to allow informed decision making. Design Systematic review using data from randomised controlled trials, nationwide databases or joint registries, and large cohort studies. Data sources Medline, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Clinical Trials.gov, searched between 1 January 1997 and 31 December 2018. Eligibility criteria for selecting studies Studies published in the past 20 years, comparing outcomes of primary UKA with TKA in adult patients. Studies were excluded if they involved fewer than 50 participants, or if translation into English was not available. Results 60 eligible studies were separated into three methodological groups: seven publications from six randomised controlled trials, 17 national joint registries and national database studies, and 36 cohort studies. Results for each domain of outcome varied depending on the level of data, and findings were not always significant. Analysis of the three groups of studies showed significantly shorter hospital stays after UKA than after TKA (−1.20 days (95% confidence interval −1.67 to −0.73), −1.43 (−1.53 to −1.33), and −1.73 (−2.30 to −1.16), respectively). There was no significant difference in pain, based on patient reported outcome measures (PROMs), but significantly better functional PROM scores for UKA than for TKA in both non-trial groups (standard mean difference −0.58 (−0.88 to −0.27) and −0.29 (−0.46 to −0.11), respectively). Regarding major complications, trials and cohort studies had non-significant results, but mortality after TKA was significantly higher in registry and large database studies (risk ratio 0.27 (0.16 to 0.45)), as were venous thromboembolic events (0.39 (0.27 to 0.57)) and major cardiac events (0.22 (0.06 to 0.86)). Early reoperation for any reason was higher after TKA than after UKA, but revision rates at five years remained higher for UKA in all three study groups (risk ratio 5.95 (1.29 to 27.59), 2.50 (1.77 to 3.54), and 3.13 (1.89 to 5.17), respectively). Conclusions TKA and UKA are both viable options for the treatment of isolated unicompartmental osteoarthritis. By directly comparing the two treatments, this study demonstrates better results for UKA in several outcome domains. However, the risk of revision surgery was lower for TKA. This information should be available to patients as part of the shared decision making process in choosing treatment options. Systematic review registration PROSPERO number CRD42018089972.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Wilson

Middleton

Abram

et al. 2019

BMJ

216

206

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“…Other studies have shown correlations between difficulty in kneeling and a reduced range of movement. 16,20,28 Despite this, our findings that numbness around TKR scars does not significantly correlate with distress or joint specific PROM scores and health related quality of life should allow clinicians to reassure patients about the impact of any numbness they may experience. Difficulty in kneeling following TKR is a complex problem and further research is needed into associations with numbness, PROMs and range of movement.…”

Section: Discussionmentioning

confidence: 78%

The effect of numbness on outcome from total knee replacement

Blackburn

Wylde

Greenwood

et al. 2017

annals

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INTRODUCTION Some patients report continuing pain and functional limitations after total knee replacement (TKR). While numbness around the TKR scar is common, the impact of numbness is less clear. One particular activity that could be influenced by numbness is kneeling. The aim of this study was to explore the impact of numbness around TKR scars on health related quality of life and kneeling ability. METHODS Fifty-six patients were recruited one year after primary TKR. Sensation around the knee was assessed through patient self-reporting, monofilament testing and vibration, and patients' distress was measured on a visual analogue scale. Patient reported outcome measures (PROMs) including the Western Ontario and McMaster Universities (WOMAC) index, the Knee injury and Osteoarthritis Outcome Score (KOOS), the painDETECT (Pfizer, Berlin, Germany) questionnaire and the EQ-5D™ (EuroQol, Rotterdam, Netherlands) questionnaire were used. Participants were also asked about kneeling ability. RESULTS While 68% of patients reported numbness around their TKR scar, there was no statistically significant correlation between numbness and distress at numbness (self-report: 0.23, p=0.08; monofilament: 0.15, p=0.27). Furthermore, numbness did not correlate significantly with joint specific PROMs (WOMAC: 0.21, p=0.13; KOOS: 0.18, p=0.19). However, difficulty with kneeling did correlate with both self-reported numbness (0.36, p=0.020) and worse PROM scores (WOMAC pain subscale: 0.62, p<0.001; KOOS: 0.64, p<0.001). CONCLUSIONS Numbness after knee replacement is common but is not associated with worse patient reported outcomes.

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“…In 2014 Okamoto et al (21) studied the weight bearing TKA kinematics in step-up activity; 37 patients (40 knees) were randomized to a MB or a FB Nexgen LPS Flex (Zimmer, Warsaw, IN, USA) TKA, being all the interventions performed by the same surgeon with a measured resection technique and without patellar resurfacing. They found no statistically significant difference between the two groups in post-operative ROM, Recently, Artz et al (22) surveyed FB and MB TKAs regarding kneeling ability, which is considered an important outcome by approximately 50% of patients. Including 206 TKAs, self-reported kneeling ability from OKS at 1 and 2 years after surgery was significantly higher in FB (from 4% preoperative to 28% at 2 years after surgery) versus MB group (from 3% preoperative to 11% at 2 years after surgery), with a significant correlation for Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain and function scores; interestingly, in spite of the difference in reported ability to kneel, ROM and WOMAC score were similar in both groups after surgery.…”

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confidence: 99%

Mobile bearing and fixed bearing total knee arthroplasty

Capella¹,

Dolfin²,

Saccia³

2016

Ann. Transl. Med.

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The mobile bearing (MB) concept in total knee arthroplasty (TKA) was developed as an alternative to fixed bearing (FB) implants in order to reduce wear and improve range of motion (ROM), especially focused on younger patients. Unfortunately, its theoretical advantages are still controversial. In this paper we exhibit a review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects, including observational studies, clinical trials, national and international registries analyses, randomized controlled trials, meta-analyses and Cochrane reviews. Except for some minor aspects, none of the studies published so far has reported a significant improvement related to MBs regarding patient satisfaction, clinical, functional and radiological outcome or medium and long-term survivorship. Thus the presumed superiority of MBs over FBs appears largely inconsistent. The routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience.

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Patient Reported Kneeling Ability in Fixed and Mobile Bearing Knee Arthroplasty

Cited by 26 publications

References 24 publications

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

The effect of numbness on outcome from total knee replacement

Mobile bearing and fixed bearing total knee arthroplasty

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