Effective treatment of knee replacement: A Synthesis of Findings from 23 Studies

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Original Abstract of the Article

Major research findings

There are various approaches used for rehabilitation after knee replacement surgery. One study, 5 , suggests that ergometer cycling can have a positive impact on health-related quality of life and patient satisfaction. Another study, 6 , compared unicompartmental knee replacement (UKA) with total knee arthroplasty (TKA), and indicated that UKA could achieve similar clinical effects as TKA. However, the study also pointed out that UKA has a higher conversion rate. On the other hand, 22 , a systematic review and meta-analysis comparing UKA and TKA, concluded that UKA is as effective as TKA for simple medial knee OA. These studies provide valuable insights for developing rehabilitation strategies after knee replacement surgery.

Treatment Summary

5 uses ergometer cycling as a treatment. 6 compares UKA and TKA as treatments. 10 uses early Tuina treatment. 21 compares TKA and UKA as treatments. 18 uses prehabilitation as a treatment.

Benefits and Risks

Benefit Summary

Knee replacement surgery is an effective treatment that can improve severe knee pain and dysfunction, enhancing quality of life. Specifically, 6 suggests that UKA could potentially achieve clinical effects similar to TKA, with the advantage of faster postoperative recovery. Additionally, 5 indicates that ergometer cycling may have a positive impact on quality of life and patient satisfaction.

Risk Summary

Like any surgery, knee replacement carries risks such as infection, blood clots, and bleeding. 6 points out that UKA has a higher conversion rate compared to TKA. Furthermore, 3 highlights the potential for patellar fracture after knee replacement, which could lead to postoperative pain and dysfunction.

Comparison between studies

Commonalities between studies

Many studies indicate that knee replacement is an effective treatment for severe knee pain and dysfunction, improving quality of life. Moreover, numerous studies emphasize the importance of postoperative rehabilitation.

Differences between studies

Each study differs in terms of patient population, treatment methods, and evaluation methods, leading to varying results. For instance, 5 evaluates the effectiveness of ergometer cycling, while other studies do not utilize this treatment. Similarly, 6 compares UKA with TKA, while other studies do not perform this comparison.

Consistency and contradictions in the results

Several studies conclude that knee replacement is an effective treatment method. However, there are contradictions, such as 6 , which suggests that UKA has a higher conversion rate compared to TKA. Additionally, 2 indicates that patellar resurfacing does not significantly impact knee function after knee replacement. These contradictions highlight the need for further research.

Cautions for real-life application

Knee replacement surgery is an effective treatment for severe knee pain and dysfunction, but obtaining adequate information before surgery is crucial. It's essential to understand the potential risks, especially the higher conversion rate associated with UKA compared to TKA, as outlined in 6 . Postoperative rehabilitation is crucial for knee function recovery. 5 suggests that ergometer cycling might positively impact quality of life and patient satisfaction. However, it's vital to undergo appropriate rehabilitation based on your individual condition and physician's instructions.

Limitations of current research

Current studies have limitations such as a small number of participants, short follow-up periods, and differences in treatment methods and evaluation procedures. Furthermore, 20 points out that patients' self-management capabilities can influence postoperative outcomes. However, this factor is not considered in many studies.

Future research directions

Future research should involve a larger number of participants and longer follow-up periods. Additionally, as suggested by 7 , interventions to enhance patients' self-management abilities, such as postoperative exercise therapy and psychotherapy, should be explored. Moreover, a more detailed analysis of the cost-effectiveness of TKA and UKA, as outlined in 19 , is necessary.

Conclusion

Knee replacement surgery is an effective treatment for severe knee pain and dysfunction. However, gaining sufficient information before surgery is crucial. Postoperative rehabilitation is essential for knee function recovery. Further research is required to thoroughly understand the safety and efficacy of knee replacement surgery.

Treatment List

Ergometer cycling, UKA, TKA, Tuina treatment, prehabilitation

Literature analysis of 23 papers
Positive Content
23
Neutral Content
0
Negative Content
0
Article Type
17
3
5
4
23
1.

Resurfacing of the patella in total knee arthroplasty. A prospective, randomized, double-blind study.

Author: BarrackR L, WolfeM W, WaldmanD A, MilicicM, BertotA J, MyersL

A study of 86 patients (118 knees) who underwent total knee replacement compared resurfacing of the patella to retaining the patella. Both groups showed significant improvement in knee function and pain, with no statistically significant differences in overall knee scores, pain levels, function, patient satisfaction, or patellofemoral joint function. While more patients who did not have patellar resurfacing experienced anterior knee pain (13% vs. 7%), the difference was not significant. Six patients in the non-resurfacing group underwent subsequent patellar resurfacing due to anterior knee pain. The study concluded that both methods produced comparable outcomes, with patellar resurfacing potentially requiring a second procedure for pain relief in some cases.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

2.

Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial.

Author: CampbellD G, DuncanW W, AshworthM, MintzA, StirlingJ, WakefieldL, StevensonT M

Improved knee function
Osteoarthritis

This study compared the outcomes of total knee replacement surgery with and without a resurfaced (smooth) patella (kneecap). The study followed 100 patients for ten years and found no significant difference in knee function or complications between the two groups. Both groups experienced a similar decline in knee scores over time, and no additional problems with the kneecap were observed. Based on these results, the study concluded that routinely resurfacing the kneecap during total knee replacement surgery is not recommended.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Management of periprosthetic patellar fractures. A systematic review of literature.

Author: ChalidisByron E, TsiridisEleftherios, TragasAdamantios A, StavrouZois, GiannoudisPeter V

Knee arthroplasty

Problems with the kneecap (patella) and the tendons that move it are common after total knee replacement surgery, often requiring additional surgery. Fractures of the kneecap after surgery happen in about 1% of cases, especially when the kneecap surface is resurfaced. Most of these fractures occur within the first two years after surgery and are not caused by an injury. Factors that can increase the risk of fracture include certain surgical techniques, implant placement, and loosening of the implant. Non-surgical treatment can be effective for minor fractures, but for more severe cases, open surgery with wiring is not usually the best option, as it has a high failure rate.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

4.

Once-weekly oral medication with alendronate does not prevent migration of knee prostheses: A double-blind randomized RSA study.

Author: HanssonUlrik, Toksvig-LarsenSören, RydLeif, AspenbergPer

Enhanced implant fixation

This study investigated whether weekly treatment with alendronate, a medication that reduces bone breakdown, could improve the initial stability of knee replacements by reducing bone loss after surgery. Early loosening of implants is a sign of poor initial stability and can predict long-term problems.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

5.

Ergometer cycling after hip or knee replacement surgery: a randomized controlled trial.

Author: LiebsThoralf R, HerzbergWolfgang, RütherWolfgang, HaastersJörg, RussliesMartin, HassenpflugJoachim

Improved patient satisfaction
Improved physical function

Ergometer cycling after total hip arthroplasty significantly improved health-related quality of life and patient satisfaction. However, there was no benefit for knee arthroplasty.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

Mobile bearing UKA compared to fixed bearing TKA: a randomized prospective study.

Author: SunPeng-Fei, JiaYu-Hua

UKA for knee arthritis
UKA conversion to TKA

This study compares the outcomes of unicompartmental knee replacement (UKA) and total knee arthroplasty (TKA) in patients with unicompartmental knee arthritis.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

7.

A randomized clinical trial of a peri-operative behavioral intervention to improve physical activity adherence and functional outcomes following total knee replacement.

Author: RosalMilagros C, AyersDavid, LiWenjun, OatisCarol, BorgAmy, ZhengHua, FranklinPatricia

Treatment of knee arthritis

Total knee replacement (TKR) is a successful surgery for severe knee arthritis. While TKR is technically successful, improvement in function after surgery varies greatly. Research suggests that consistent exercise and activity after TKR are linked to better function, and that mental well-being plays a role in this. As TKR becomes more common in older adults, finding ways to maximize functional outcomes is crucial.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

8.

The Warwick patellofemoral arthroplasty trial: a randomised clinical trial of total knee arthroplasty versus patellofemoral arthroplasty in patients with severe arthritis of the patellofemoral joint.

Author: OdumenyaMichelle, McGuinnessKatie, AchtenJuul, ParsonsNick, SpaldingTim, CostaMatthew

Improved knee arthritis treatment

This study aims to compare the outcomes of patellofemoral arthroplasty and total knee arthroplasty in patients with isolated patellofemoral joint arthritis, recognizing the potential benefits of patellofemoral arthroplasty in preserving knee joint structures.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

9.

Total knee replacement plus physical and medical therapy or treatment with physical and medical therapy alone: a randomised controlled trial in patients with knee osteoarthritis (the MEDIC-study).

Author: SkouSoren T, RoosEwa M, LaursenMogens B, RathleffMichael S, Arendt-NielsenLars, SimonsenOle H, RasmussenSten

Improved KOA treatment

This randomized controlled trial aims to examine whether total knee arthroplasty (TKA) provides additional benefits in pain, function, and quality of life compared to optimized non-surgical treatment for patients with knee osteoarthritis (KOA).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

[Effects of early application of Tuina treatment on quadriceps surface myoelectricity in patients after total knee arthroplasty: a randomized controlled trial].

Author: WangNian-hong, YanJun-tao, SunWu-quan, HuYong-shan, XiaJun, WeiLi-cheng, JiaJie, OuyangGui-lin, HeYong, GuoYan-ming, XuJie

Knee replacement recovery

Tuina treatment, combined with continuous passive training (CPM), improved the recovery of patients who had undergone total knee replacement surgery by increasing quadriceps electromyography (EMG).

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : Chinese

11.

Patellar resurfacing in primary total knee replacement: a meta-analysis.

Author: PillingR W D, MoulderE, AllgarV, MessnerJ, SunZ, MohsenA

Reduced reoperation
Patellofemoral complications

Patellar resurfacing in primary total knee replacement was found to be associated with fewer additional surgical procedures, but there was no significant difference in knee scores, anterior knee pain or patient satisfaction compared to nonresurfacing.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : English

12.

Effect of pre-operative neuromuscular training on functional outcome after total knee replacement: a randomized-controlled trial.

Author: HuberErika O, de BieRob A, RoosEwa M, Bischoff-FerrariHeike A

TKR outcome

Total knee replacement (TKR) is a common procedure for severe knee osteoarthritis, improving pain and function for most patients (about 80% are satisfied). How well someone functions before surgery is a major factor in how well they do after. Therefore, exercise before surgery to improve function may lead to better outcomes, but previous studies have had mixed results.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

Total or Partial Knee Arthroplasty Trial - TOPKAT: study protocol for a randomised controlled trial.

Author: BeardDavid, PriceAndrew, CookJonathan, FitzpatrickRay, CarrAndrew, CampbellMarion, DollHelen, CampbellHelen, ArdenNigel, CooperCushla, DaviesLoretta, MurrayDavid

Osteoarthritis treatment

Most knee osteoarthritis affects the inner part of the knee. There are two different surgical approaches for this: replacing the entire knee (total knee replacement, TKR) or just the affected part (unicompartmental knee replacement, UKR). While both are established procedures, there's limited evidence to determine which approach is best. This study aims to compare the effectiveness and cost of TKR vs. UKR for patients with osteoarthritis in the inner knee compartment.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

14.

The effects of total knee replacement and non-surgical treatment on pain sensitization and clinical pain.

Author: SkouS T, RoosE M, SimonsenO, LaursenM B, RathleffM S, Arendt-NielsenL, RasmussenS

Pain sensitization reduction

Total knee replacement followed by non-surgical treatment is more effective in reducing localized and spreading pain sensitization than non-surgical treatment alone at 3 months. Both treatments are equally efficacious in reducing other pain-related measures.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

15.

Satisfactory outcomes following combined unicompartmental knee replacement and anterior cruciate ligament reconstruction.

Author: VolpinAndrea, KiniS G, MeuffelsD E

This systematic review examines the combination of anterior cruciate ligament (ACL) reconstruction and unicompartmental knee arthroplasty for treating patients with combined medial compartment arthritis and ACL deficiency. The study explores the potential benefits and risks of this combined approach.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

16.

A Physical Therapist-Administered Physical Activity Intervention After Total Knee Replacement: Protocol for a Randomized Controlled Trial.

Author: ChristiansenMeredith B, ThomaLouise M, MasterHiral, SchmittLaura A, PohligRyan, WhiteDaniel K

Increased PA

This randomized controlled trial will investigate the efficacy, fidelity, and safety of a physical therapist-administered physical activity intervention for individuals after total knee replacement.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

17.

How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.

Author: EvansJonathan T, WalkerRobert W, EvansJonathan P, BlomAshley W, SayersAdrian, WhitehouseMichael R

Long-lasting knee replacements

Based on pooled registry data, approximately 82% of total knee replacements (TKRs) last 25 years and 70% of unicondylar knee replacements (UKRs) last 25 years. These findings can inform patients and healthcare providers about the long-term durability of knee replacements.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

18.

The Effect of Prehabilitation on Postoperative Outcome in Patients Following Primary Total Knee Arthroplasty.

Author: JahicDzenan, OmerovicDjemil, TanovicAdnana Talic, DzankovicFuad, CamparaMerita Tiric

Preoperative exercise
TKA treatment

This study investigates the effectiveness of pre-operative exercise (prehabilitation) for patients undergoing total knee replacement surgery (TKA). While knee replacement is a common and effective treatment for severe osteoarthritis (OA), the role of pre-surgery exercise is still debated. The study aims to determine if prehabilitation improves outcomes for these patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

19.

The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial.

Author: BeardDavid J, DaviesLoretta J, CookJonathan A, MacLennanGraeme, PriceAndrew, KentSeamus, HudsonJemma, CarrAndrew, LealJose, CampbellHelen, FitzpatrickRay, ArdenNigel, MurrayDavid, CampbellMarion K,

Late-stage isolated medial knee osteoarthritis treatment
PKR
TKR

This study, called TOPKAT, compared the effectiveness and cost of total knee replacement (TKR) versus partial knee replacement (PKR) for patients with osteoarthritis only affecting the inner side of the knee. The 5-year results of the study aim to provide evidence for choosing the best treatment option for this specific type of osteoarthritis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Pragmatic Clinical TrialA trial conducted in a real-world clinical setting. It evaluates the effectiveness of interventions in everyday healthcare environments.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

20.

The Effect of an App for Day-to-Day Postoperative Care Education on Patients With Total Knee Replacement: Randomized Controlled Trial.

Author: TimmersThomas, JanssenLoes, van der WeegenWalter, DasDirk, MarijnissenWillem-Jan, HanninkGerjon, van der ZwaardBabette C, PlatAdriaan, ThomassenBregje, SwenJan-Willem, KoolRudolf B, Lambers HeerspinkFrederik Okke

Improved TKR outcomes

This study explores the use of active communication strategies to improve patient self-management after total knee replacement (TKR) surgery, as patients often struggle to understand and follow discharge instructions.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

21.

Total versus partial knee replacement in patients with medial compartment knee osteoarthritis: the TOPKAT RCT.

Author: BeardDavid J, DaviesLoretta J, CookJonathan A, MacLennanGraeme, PriceAndrew, KentSeamus, HudsonJemma, CarrAndrew, LealJose, CampbellHelen, FitzpatrickRay, ArdenNigel, MurrayDavid, CampbellMarion K

Cost-effective
Improved function
Knee pain relief
Reoperation
Revision

Partial knee replacement and total knee replacement were equally effective in treating late-stage medial compartment knee osteoarthritis, with similar clinical outcomes, reoperation rates, and complication rates. Partial knee replacement was found to be more cost-effective than total knee replacement.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Pragmatic Clinical TrialA trial conducted in a real-world clinical setting. It evaluates the effectiveness of interventions in everyday healthcare environments.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

22.

Unicondylar knee replacement versus total knee replacement for the treatment of medial knee osteoarthritis: a systematic review and meta-analysis.

Author: DengMeichao, HuYang, ZhangZhongzu, ZhangHongjun, QuYiming, ShaoGaohai

Improved knee function
Revision surgery

Unicondylar knee replacement (UKR) was more effective than total knee replacement (TKR) for isolated medial knee osteoarthritis in terms of improving knee function and health, reducing pain and complications. There were no significant differences between the two techniques in postoperative revision rates in the early and mid-term follow-up.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

23.

Early post-operative physiotherapy rehabilitation after primary unilateral unicompartmental knee replacement: a systematic review.

Author: JenkinsCathy, LoweCatherine Minns, BarkerKaren L

UKR recovery
Minimal physiotherapy input

This review highlights the variability in post-operative physiotherapy provision following unicompartmental knee replacement (UKR) with a recent trend towards minimal physiotherapy input. Further research is required to identify patients who may need additional physiotherapy and to determine the most effective timing, type, and dosage of intervention.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

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