Supervised versus unsupervised rehabilitation following total knee arthroplasty: A systematic review and meta-analysis

Bravi, Marco; Longo, Umile Giuseppe; Laurito, Andrea; Greco, Alessandra; Marino, Martina; Maselli, Mirella; Sterzi, Silvia; Santacaterina, Fabio

doi:10.1016/j.knee.2022.11.013

Cited by 12 publications

(11 citation statements)

References 46 publications

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“…In addition, we did not examine the effect of rehabilitation on patient outcomes after TKR in this study. Rehabilitation is recommended for TKR [ 51 ] but is a very complex area with recent reviews examining different timing, type, and duration [ 11 , 12 , 52 ]. As these studies have been on patients with primary OA, the results cannot be extrapolated to other diseases of the knee such as inflammatory or injury-induced arthritis.…”

Section: Discussionmentioning

confidence: 99%

“…The question remains as to whether these results are replicated for older adults aged over 65 years, a population with increased comorbidities and worse functional and psychosocial status but representing a significant proportion of those undergoing TKR [ 9 , 10 ]. While rehabilitation plays a role in improving pain, function, and mobility outcomes after TKR [ 11 , 12 ], there is evidence that the preoperative conditions of the patients, including pain, functional status, psychosocial factors, and comorbidities, are very important in terms of determining outcomes after TKR [ 13 , 14 , 15 , 16 ]. The effectiveness of surgical intervention and patient satisfaction following TKR in patients aged over 65 years remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Patient-Reported Outcomes following Total Knee Replacement in Patients Aged 65 Years and Over—A Systematic Review

Woodland

Takla

Estee

et al. 2023

JCM

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A previous systematic review showed positive patient-reported outcomes following total knee replacement (TKR) in patients aged < 65 years. However, the question remains as to whether these results are replicated for older individuals. This systematic review evaluated the patient-reported outcomes following TKR in individuals aged ≥ 65 years. A systematic search of Ovid MEDLINE, EMBASE, and Cochrane library were performed to identify studies examining disease-specific or health-related quality of life outcomes following TKR. Qualitative evidence synthesis was performed. Eighteen studies with low (n = 1), moderate (n = 6), or serious (n = 11) overall risk of bias were included, with evidence syntheses derived from 20,826 patients. Four studies reported on pain scales, showing improvement of pain from 6 months to 10 years postoperatively. Nine studies examined functional outcomes, showing significant improvements from 6 months to 10 years after TKR. Improvement in health-related quality of life was evident in six studies over 6 months to 2 years. All four studies examining satisfaction reported overall satisfaction with TKR results. TKR results in reduced pain, improved function, and increased quality of life for individuals aged ≥ 65 years. The improvement in patient-reported outcomes needs to be utilised in conjunction with physician expertise to determine what would comprise clinically significant differences.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient-Reported Outcomes following Total Knee Replacement in Patients Aged 65 Years and Over—A Systematic Review

Woodland

Takla

Estee

et al. 2023

JCM

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“…Warren et al [ 32 ] in a comparative study on sagittal laxity among PS, CR, and double cruciate retention prostheses observed an increase in ROM max in patients with AP translation >5 mm, regardless of the type of prosthetic implant used, but did not identify a pathological upper limit of translation. Matsumoto et al [ 33 , 34 ], evaluated in 110 knees undergoing PS TKR the association between sagittal laxity at 30°, 60°, and 90° knee flexion and functional outcomes and observed a significant decrease in the K-pain score with increasing AP translation at 60° knee flexion.…”

Section: Discussionmentioning

confidence: 99%

The Correlation between Objective Ligament Laxity and the Clinical Outcome of Mechanically Aligned TKA

Campi,

Papalia,

Esposito

et al. 2023

JCM

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Instability is one of the causes of failure in total knee arthroplasty (TKA). The aim of this study was to analyze the correlation between objective ligament laxity and the clinical outcome of mechanically aligned TKA. Fifty-one knees in 47 patients were evaluated at a minimum follow-up of 6 months. The correlation between the angular displacement and functional scores (Knee Society Score and Knee Injury and Osteoarthritis Score) was analyzed. A negative correlation (p-value < 0.05) was observed between medial laxity ≥5° at 0, 30, 60, and 90° of flexion and the outcome measures. Lateral laxity did not correlate with the clinical outcome. At 30° of knee flexion, a total varus and valgus laxity ≥10° was related to poorer outcomes. The same amount of angular displacement did not influence the outcome in the other flexion angles. There was no difference in single-radius vs multi-radius implants in terms of medial and lateral laxity and clinical outcome. A valgus displacement ≥5° measured at 0, 30, 60, and 90 degrees of flexion correlated with an inferior clinical outcome. In contrast, the same amount of displacement measured on the lateral compartment did not influence the clinical outcome after TKA.

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“…This review and meta-analysis from Rome (Italy) assessed the influence of supervised versus unsupervised rehabilitation following TKA and included eleven randomized controlled trials. 6 They demonstrated no differences in pain outcome, physical function, or range of motion in flexion or extension. However, supervised rehabilitation was associated with a better six-minute walking test and Timed Up and Go test at 52 weeks.…”

Section: Supervised Versus Unsupervised Rehabilitation Following Tota...mentioning

confidence: 90%

Knee

2023

Bone & Joint 360

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The February 2023 Knee Roundup360 looks at: Machine-learning models: are all complications predictable?; Positive cultures can be safely ignored in revision arthroplasty patients that do not meet the 2018 International Consensus Meeting Criteria; Spinal versus general anaesthesia in contemporary primary total knee arthroplasty; Preoperative pain and early arthritis are associated with poor outcomes in total knee arthroplasty; Risk factors for infection and revision surgery following patellar tendon and quadriceps tendon repairs; Supervised versus unsupervised rehabilitation following total knee arthroplasty; Kinematic alignment has similar outcomes to mechanical alignment: a systematic review and meta-analysis; Lifetime risk of revision after knee arthroplasty influenced by age, sex, and indication; Risk factors for knee osteoarthritis after traumatic knee injury.

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Supervised versus unsupervised rehabilitation following total knee arthroplasty: A systematic review and meta-analysis

Cited by 12 publications

References 46 publications

Patient-Reported Outcomes following Total Knee Replacement in Patients Aged 65 Years and Over—A Systematic Review

Patient-Reported Outcomes following Total Knee Replacement in Patients Aged 65 Years and Over—A Systematic Review

The Correlation between Objective Ligament Laxity and the Clinical Outcome of Mechanically Aligned TKA

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