Preoperative Quadriceps Muscle Strength and Functional Ability Predict Performance-Based Outcomes 6 Months after Total Knee Arthroplasty: A Systematic Review

Abstract

Background One-Third of individuals report limitations in activities of daily living even 6 months after total knee arthroplasty (TKA). Moderate-quality evidence exists for several sociodemographic and clinical predictors of patient-reported outcome measures of perceived functionality. Objectively measured performance-based measures (PBMs) provide a less subjective approach to informing patient treatment after TKA; however, information about predictors of functionally relevant PBMs is scarce. Purpose This systematic review synthesized the available research on preoperative predictors of PBMs after primary TKA for osteoarthritis. Data Sources In June 2016 and January 2017, MEDLINE, EMBASE, and PsycINFO databases were searched. Study Selection Cohort studies exploring preoperative predictors of stair climbing, walking speed, and gait speed measured ≥6 months after primary TKA were included. Screening of abstracts and selection of full texts were undertaken by 2 independent reviewers. Data Extraction Information on study design, patient characteristics, analysis, and results was extracted using pilot-Tested forms. Two independent reviewers assessed risk of bias using modified Quality in Prognostic Studies criteria. Data Synthesis Of the eligible 12 studies involving 6 prospective cohorts, 10 studies reported information on baseline predictors. Meta-Analysis of predictors was not possible because of missing information on effect size or standard errors. Narrative synthesis of evidence of predictors was therefore performed. Limitations The quality of evidence was low because of the risk of bias and heterogeneity of included studies as well as nonreporting of measures of effect. Conclusions Low-quality evidence exists for an association of preoperative functional ability and quadriceps muscle strength with functionality at 6 months after TKA. Improved reporting of predictor analyses is needed to enable evidence generation for clinical management.