Functional assessment in patients undergoing total knee arthroplasty : a systematic review.

Abstract

Aims: Traditional methods of measuring patient satisfaction and improvement after total knee arthroplasy (TKA) rely on patient-reported outcome measures (PROMs), which are subjective and prone to recall bias. As a result, there has been a considerable recent increase in the use of objective functional assessments to quantify improvement in patients undergoing TKA. However, the functional assessments used in the literature are many and diverse. The aim of this systematic review was to investigate and synthesize all the objective methods of functional assessment which are recorded pre- and postoperatively, and used to measure improvement in these patients.

Methods: The review was conducted according to the PRISMA guidelines. Eligible studies in English of patients who underwent TKA, in which at least one objective assessment of pre- and postoperative function was reported, were identified from a literature search on PubMed, Embase, and Cochrane Central databases from their inception to 1 September 2024 and included. Subgroup analyses included gait analysis, motion analysis, walking tests, wearables/sensors, and strength tests.

Results: A total of 314 studies using 21 unique categories of functional assessment were included. The three most common methods of assessment were the Timed Up and Go test, traditional gait analysis, and the use of a dynamometer to quantify quadriceps strength. There has been a considerable increase in the use of functional assessments for patients undergoing TKA in recent years, with a wide range of tools being used to collect spatiotemporal, kinetic, and kinematic data.

Conclusion: This systematic review highlights the diversity of the functional assessments which are used to evaluate a patient's mobility both before and after undergoing TKA. The findings may serve as a summary of the advantages, disadvantages, and details of each assessment. The further integration of advanced functional technologies, such as markerless motion capture, holds promise for enhancing the accuracy and convenience of the analysis of function in these patients, and others in varied settings.