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The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression
PURPOSE: Muscular strength loss and atrophy are postoperative complications. This systematic review with meta-analysis investigated the course of on knee extensor mass and strength from pre-surgery over total knee arthroplasty to rehabilitation and recovery. METHODS: A systematic literature search w...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10374784/ https://www.ncbi.nlm.nih.gov/pubmed/36637491 http://dx.doi.org/10.1007/s00402-022-04750-5 |
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author | Singla, Ravi Niederer, Daniel Franz, Alexander Happ, Kevin Zilkens, Christoph Wahl, Patrick Behringer, Michael |
author_facet | Singla, Ravi Niederer, Daniel Franz, Alexander Happ, Kevin Zilkens, Christoph Wahl, Patrick Behringer, Michael |
author_sort | Singla, Ravi |
collection | PubMed |
description | PURPOSE: Muscular strength loss and atrophy are postoperative complications. This systematic review with meta-analysis investigated the course of on knee extensor mass and strength from pre-surgery over total knee arthroplasty to rehabilitation and recovery. METHODS: A systematic literature search was conducted in PubMed (Medline), Cochrane Library (CINAHL, Embase) and Web of Science (until 29th of June 2022). Main inclusion criteria were ≥ 1 preoperative and ≥ 1 measurement ≥ 3-months post-operation and ≥ 1 objective assessment of quadriceps strength, muscle mass or neuromuscular activity, measured at both legs. Studies were excluded if they met the following criteria: further impairment of treated extremity or of the contralateral extremity; further muscle affecting disease, or muscle- or rehabilitation-specific intervention. The Robins-I tool for non-randomized studies, and the Cochrane Rob 2 tool for randomized controlled studies were used for risk of bias rating. Pre-surgery, 3 months, 6 months and 1 year after surgery data were pooled using random effects meta-analyses (standardized mean differences, SMD, Hedge’s g) in contrast to the pre-injury values. RESULTS: 1417 studies were screened, 21 studies on 647 participants were included. Thereof, 13 were non-randomized controlled trails (moderate overall risk of bias in most studies) and 7 were randomized controlled trials (high risk of bias in at least one domain in most studies). Three (k = 12 studies; SMD = − 0.21 [95% confidence interval = − 0.36 to − 0.05], I(2) = 4.75%) and six (k = 9; SMD = − 0.10 [− 0.28 to − 0.08]; I(2) = 0%) months after total knee arthroplasty, a deterioration in the strength of the operated leg compared with the strength of the non-operated leg was observed. One year after surgery, the operated leg was stronger in all studies compared to the preoperative values. However, this increase in strength was not significant compared to the non-operated leg (k = 6, SMD = 0.18 [− 0.18 to 0.54], I(2) = 77.56%). CONCLUSION: We found moderate certainty evidence that deficits in muscle strength of the knee extensors persist and progress until 3 months post-total knee arthroplasty in patients with end-stage knee osteoarthritis. Very low certainty evidence exists that preoperatively existing imbalance of muscle strength and mass in favor of the leg not undergoing surgery is not recovered within 1 year after surgery. |
format | Online Article Text |
id | pubmed-10374784 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-103747842023-07-29 The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression Singla, Ravi Niederer, Daniel Franz, Alexander Happ, Kevin Zilkens, Christoph Wahl, Patrick Behringer, Michael Arch Orthop Trauma Surg Knee Arthroplasty PURPOSE: Muscular strength loss and atrophy are postoperative complications. This systematic review with meta-analysis investigated the course of on knee extensor mass and strength from pre-surgery over total knee arthroplasty to rehabilitation and recovery. METHODS: A systematic literature search was conducted in PubMed (Medline), Cochrane Library (CINAHL, Embase) and Web of Science (until 29th of June 2022). Main inclusion criteria were ≥ 1 preoperative and ≥ 1 measurement ≥ 3-months post-operation and ≥ 1 objective assessment of quadriceps strength, muscle mass or neuromuscular activity, measured at both legs. Studies were excluded if they met the following criteria: further impairment of treated extremity or of the contralateral extremity; further muscle affecting disease, or muscle- or rehabilitation-specific intervention. The Robins-I tool for non-randomized studies, and the Cochrane Rob 2 tool for randomized controlled studies were used for risk of bias rating. Pre-surgery, 3 months, 6 months and 1 year after surgery data were pooled using random effects meta-analyses (standardized mean differences, SMD, Hedge’s g) in contrast to the pre-injury values. RESULTS: 1417 studies were screened, 21 studies on 647 participants were included. Thereof, 13 were non-randomized controlled trails (moderate overall risk of bias in most studies) and 7 were randomized controlled trials (high risk of bias in at least one domain in most studies). Three (k = 12 studies; SMD = − 0.21 [95% confidence interval = − 0.36 to − 0.05], I(2) = 4.75%) and six (k = 9; SMD = − 0.10 [− 0.28 to − 0.08]; I(2) = 0%) months after total knee arthroplasty, a deterioration in the strength of the operated leg compared with the strength of the non-operated leg was observed. One year after surgery, the operated leg was stronger in all studies compared to the preoperative values. However, this increase in strength was not significant compared to the non-operated leg (k = 6, SMD = 0.18 [− 0.18 to 0.54], I(2) = 77.56%). CONCLUSION: We found moderate certainty evidence that deficits in muscle strength of the knee extensors persist and progress until 3 months post-total knee arthroplasty in patients with end-stage knee osteoarthritis. Very low certainty evidence exists that preoperatively existing imbalance of muscle strength and mass in favor of the leg not undergoing surgery is not recovered within 1 year after surgery. Springer Berlin Heidelberg 2023-01-13 2023 /pmc/articles/PMC10374784/ /pubmed/36637491 http://dx.doi.org/10.1007/s00402-022-04750-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Knee Arthroplasty Singla, Ravi Niederer, Daniel Franz, Alexander Happ, Kevin Zilkens, Christoph Wahl, Patrick Behringer, Michael The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression |
title | The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression |
title_full | The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression |
title_fullStr | The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression |
title_full_unstemmed | The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression |
title_short | The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression |
title_sort | course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression |
topic | Knee Arthroplasty |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10374784/ https://www.ncbi.nlm.nih.gov/pubmed/36637491 http://dx.doi.org/10.1007/s00402-022-04750-5 |
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