Clinical outcomes and quality of life after Total Knee Replacement (TKR) - A systematic review

Abstract Background The current review aimed to refresh the existing evidence on clinical effectiveness of Total Knee Replacement (TKR) in various settings, using a wide follow-up window, and to examine the determinants influencing the success of TKR, so the evidence can be systematically synthesized. Methodology Studies only with pre-post study designs, measuring patient reported outcome measures (PROMs) at two time points, pre-TKR and post-TKR, were included. Commonly used PROMs, such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form (SF-36) were harmonized across studies from worst to best and in the range of 0-100 scale. Effect Sizes (ES) were computed using pre-post mean differences in PROMs, quantifying post-TKR changes in the OA-affected knee. Results A total of 27 studies were included in this review. During short-term follow-up (≤ 6 months), greater improvement in WOMAC components such as pain (ES = 2.0) and function (ES = 2.3) was observed as opposed to stiffness. There was an improvement in all the scales of SF-36 except general health post-TKR. Gender (female), co-morbidities and post-operative complications were associated with poor outcomes of TKR. Discussion Improvement in clinical outcomes and performance was observed after TKR, especially between 6 months and 1 year. There was less improvement in PROMs in the long term but without any deterioration within 10 years of follow-up period. Conclusion The overall findings of this review conclude the confirmation of older knowledge with fresh evidence that TKR is definitely a clinically effective and beneficial treatment for individuals with OA knee and that too in different settings. Systematic review registration The systematic review protocol was registered in INPLASY (Registration No: INPLASY202240166)