The effects of total knee arthroplasty on knee proprioception of patients with knee osteoarthritis: a meta-analysis

Abstract

Background Studies have given some pieces of evidence for the effect of total knee arthroplasty (TKA) on knee proprioception of patients with knee osteoarthritis (KOA), but their results were conflicting. This review was performed to provide an updated evidence-based meta-analysis investigating the influence of TKA on knee proprioception. Methods The electronic databases including PubMed, Google Scholar, and the Cochrane Library were accessed from their inception to March 2020. Two reviewers identified the studies that met the selection criteria for this review. Information on study type, participants, follow-up time, and outcome measures was extracted. Methodological quality was independently assessed by two reviewers using the Cochrane Handbook 5.1.0. Eleven studies with 475 participants were included in the meta-analysis. Results The I2 index assessed the heterogeneity between studies. The results showed that the pooled standard mean difference of mean angle of error was − 0.58° (95% CI − 1 to – 0.16; P = 0.007; I2 = 69%), and the joint position sense of KOA patients was better after TKA surgery than that before surgery. Pooled standard mean difference of displacement of center of pressure (COP) was − 0.39 (95% CI − 0.72 to − 0.06; P = 0.02; I2 = 51%), and KOA patients had better static balance after TKA surgery than before surgery. Conclusions To conclude, no standardized comprehensive evaluation protocol presently exists though different assessment tools are available to measure proprioception. Contrasting results were found in the literature since some studies found that TKA improves proprioception in KOA patients, while others found no difference in proprioception. These differences are seen whether the proprioception was assessed by joint position sense (JPS), or it was indirectly assessed by static balance. However, the lack of sufficient data on the threshold to detect passive movement (TTDPM) and dynamic balance made it difficult to draw a conclusion about whether or not the sense of motion improved after surgery. The method for measuring and evaluating knee joint force sense is worth paying attention, which will make progress with knee proprioception on TKA patients.

Investigating Knee Joint Proprioception and Its Impact on Limits of Stability Using Dynamic Posturography in Individuals with Bilateral Knee Osteoarthritis—A Cross-Sectional Study of Comparisons and Correlations

“…Regarding the muscles around the knee, changes in the cross-sectional area and fatty degeneration of the knee muscles due to arthritis have been reported [48]. Additionally, decreased knee proprioceptive capacity will have an effect on the limits of stability in KOA individuals [13], since reduced proprioceptive afferent input to higher centers will modify the peripheral motor output, resulting in impaired somatomotor control [49]. Sanchez-Ramirez et al [50] showed that postural control is altered and proprioceptive accuracy is impaired in 284 KOA individuals.…”

“…Different authors have demonstrated increased knee joint positioning errors (JPE) in KOA individuals compared to age-matched asymptomatic individuals [9][10][11][12]. Different factors, such as degeneration, decreased muscle strength, and endurance, impair mechanoreceptor function, and thereby affect afferent proprioceptive input to the higher centers, resulting in altered motor output and proprioceptive function [13,14].…”

Knee osteoarthritis: Current status and research progress in treatment (Review)

“…However, the effects of surgical treatment may be influenced by factors such as pain, joint function, anatomical factors and patient's physical function (152). Current surgical treatment methods for KOA include knee arthroscopy (153), bone marrow stimulation (154) and osteotomy (155)(156)(157) and joint replacement (158), fusion (159) and arthroplasty (160). For patients with early-to-mid-stage KOA, joint arthroscopy is a better option as it provides the advantages of a smaller wound and rapid recovery (153).…”

Investigation of mid-term functional skills and psychological factors in female patients undergoing total knee arthroplasty

“…Researchers have notably underscored the importance of assessing proprioception, particularly within patient cohorts like those with OA, given its strong correlation with knee functional performance [65]. Generally, a trend toward enhanced proprioception levels post-TKA is recognized [65,66]. Nevertheless, some studies report no significant difference in proprioception levels between the preoperative and postoperative phases [67,68].…”