Authors' objectives:

The aim of this review was to assess the effectiveness, in terms of pain reduction and functional improvement, and costing of total knee replacement (TKR) for people with osteoarthritis for whom less invasive treatments (such as physiotherapy, analgesics, anti-inflammatory drugs, intra-articular steroids, hyaluronic acids, and arthroscopic surgery) have failed.

Authors' results and conclusions: Overall, patients who undergo TKR surgery for osteoarthritis have substantial improvements in terms of reduction of pain and improvement of function. A comparison of the mean effect score and the percent change in 19 studies that reported preoperative and postoperative outcome scores for patients who had TKR showed that the procedure is effective. The 19 studies included patients of various ages and used a variety of prostheses and techniques to implant the device. TKR was effective in all of the studies. The revision rates ranged from 0% to 13% in the studies that reported at least 5 years of follow-up. As for the factors that predict TKR outcomes, a variety of factors have been evaluated, including obesity, age, gender, prosthesis design, and surgical techniques; however, none of these have been shown to predict outcomes (pain or function) consistently across studies. However, the regression analyses identified accounted for only 12% to 27% of the variance, indicating that over 70% of the variance in the outcomes of TKR is unexplained. In terms of the timing of TKR surgery, 2 studies found that the severity of osteoarthritis does not predict outcome, but 1 study was found that higher functioning patients had significantly less pain and better function up to 2 years after surgery compared with lower functioning patients. It is important to note that the patients in the low and high function groups were evenly matched on comorbid conditions. Unicompartmental knee replacement surgery seems to be as effective as TKR surgery for people who meet the indications for it. This is a subset of people who have osteoarthritis of the knee, because for unicompartmental knee replacement to be indicated, only 1 (usually the medial) compartment of the knee can be affected. Patients who undergo this kind of surgery seem to have shorter hospital stays and faster recovery times than do patients who have TKR surgery.

Authors' recommendations: There is substantial evidence to indicate that TKR effectively reduces pain and improves function.

Authors' methods: Systematic review

Project Status: Completed

Year Published: 2005

URL for published report: http://www.health.gov.on.ca/english/providers/program/mas/tech/reviews/pdf/rev_tkr_061705.pdf

URL for additional information: http://www.hqontario.ca/evidence/publications-and-ohtac-recommendations/ohtas-reports-and-ohtac-recommendations/total-knee-replacement

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care