Schache Margaret B, McClelland Jodie A, Webster Kate E
Department of Physiotherapy, School of Allied Health, La Trobe University, Melbourne, Australia; Donvale Rehabilitation Hospital, Ramsay Health Care, Melbourne, Australia.
Department of Physiotherapy, School of Allied Health, La Trobe University, Melbourne, Australia; Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Melbourne, Australia.
Knee. 2014 Jan;21(1):12-20. doi: 10.1016/j.knee.2013.08.002. Epub 2013 Aug 15.
Total knee arthroplasty (TKA) is commonly performed for end-stage knee osteoarthritis to relieve pain and improve quality of life. Understanding specific muscle weakness following TKA is required in order to develop targeted rehabilitation programmes for TKA patients. The aim of this systematic review was to determine whether TKA patients have reduced strength in lower limb muscle groups compared to controls.
A search of common scientific databases was conducted. A modified published checklist was used to assess the risk of bias. A meta-analysis was completed for each lower limb muscle group in three separate post-operative time periods (4-6 months, 1-3 years, and >3 years). The GRADE approach was used to determine the quality of the evidence.
Fifteen studies met the inclusion criteria for this review. There was low quality evidence for all meta-analyses. The meta-analyses showed that TKA patients had weaker quadriceps than the controls at every post-operative time (pooled effect sizes between -2.81 and -0.53). The meta-analyses of hamstring strength for patients 1-3 years post-operatively also showed patient weakness (pooled effect size=-1.87) and no significant difference at >3 years post-operatively (pooled effect size=-0.20).
There was low quality evidence of quadriceps and hamstring weakness following TKA. Further research is required to determine if other lower limb muscles also display similar muscle weakness. Strategies that specifically target strengthening of these muscle groups may need to be incorporated in rehabilitation to improve outcomes from TKA.
I.
全膝关节置换术（TKA）常用于终末期膝关节骨关节炎，以缓解疼痛并改善生活质量。为了制定针对TKA患者的有针对性的康复计划，需要了解TKA后特定的肌肉无力情况。本系统评价的目的是确定与对照组相比，TKA患者下肢肌肉群的力量是否降低。
对常见科学数据库进行检索。使用修改后的已发表清单评估偏倚风险。在三个不同的术后时间段（4 - 6个月、1 - 3年和>3年）对每个下肢肌肉群进行荟萃分析。采用GRADE方法确定证据质量。
15项研究符合本评价的纳入标准。所有荟萃分析的证据质量都很低。荟萃分析表明，在每个术后时间点，TKA患者的股四头肌比对照组弱（合并效应量在 - 2.81至 - 0.53之间）。术后1 - 3年患者的腘绳肌力量荟萃分析也显示患者存在无力情况（合并效应量 = - 1.87），术后>3年无显著差异（合并效应量 = - 0.20）。
有低质量证据表明TKA后存在股四头肌和腘绳肌无力。需要进一步研究以确定其他下肢肌肉是否也表现出类似的肌肉无力。可能需要在康复中纳入专门针对加强这些肌肉群的策略，以改善TKA的效果。
I级
