What's important for recovery after a total knee replacement? A systematic review of mixed methods studies

Chetan Khatri; Imran Ahmed; Fatema Dhaif; Jeremy Rodrigues; Martin Underwood; Edward T Davis; Paul Mitchell; Andrew Metcalfe

doi:10.1007/s00402-023-05136-x

What's important for recovery after a total knee replacement? A systematic review of mixed methods studies

Arch Orthop Trauma Surg. 2023 Dec 9. doi: 10.1007/s00402-023-05136-x. Online ahead of print.

Authors

Chetan Khatri^{1

2}, Imran Ahmed³, Fatema Dhaif³, Jeremy Rodrigues³, Martin Underwood³, Edward T Davis⁴, Paul Mitchell⁵, Andrew Metcalfe³

Affiliations

¹ Clinical Trials Unit, University of Warwick, Coventry, UK. Chetan.khatri@gmail.com.
² Clinical Sciences Research Laboratories, University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK. Chetan.khatri@gmail.com.
³ Clinical Trials Unit, University of Warwick, Coventry, UK.
⁴ Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
⁵ Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, UK.

PMID: 38070014
DOI: 10.1007/s00402-023-05136-x

Abstract

Background: Understanding how patients perceive and prioritise various aspects of recovery following total knee replacement, including pain, function and return to activity, will help clinicians in pre-operative consultations by ensuring they effectively address patient concerns and managing their expectations.

Aims: The aim of this study is to identify aspects of recovery that are important to people after a total knee replacement.

Methods: Studies were identified from Medline, Embase, PsycInfo, Cochrane Library and Web of Science. This mixed methods review included all original study types (quantitative, qualitative, discrete choice experiments and mixed methods design). Reviews and non-peer-reviewed publications were excluded. Studies with participants (age ≥ 18 years) who had a primary TKR for osteoarthritis were included. Studies of people with unicompartmental knee, patella-femoral or revision knee replacement were excluded. Recovery attributes were extracted from individual papers and grouped into recovery themes.

Results: A total of 23 studies with 8404 participants and 18 recovery themes were developed. The most frequently identified overarching theme was pain, followed by activities of daily living, mobility (walking), recreational activities, specific functional movements of the knee, use of walking aids, sexual activity and range of motion of the knee. Medical complications were an infrequently reported theme, however, was deemed to be high importance.

Conclusions: Reducing pain, returning of activities and daily living and mobility are the three most frequently reported recovery domains for people after TKR. Clinicians should be aware of recovery themes, to ensure they are explored sufficiently when consenting for a TKR. Future research should aim to determine the relative importance of these attributes compared to each other. Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021253699.

Keywords: Attributes; Discrete choice experiment; Mixed methods review; Total knee replacement.

Publication types

Review