School of Biomedical Engineering, Capital Medical University, No. 10 Xitoutiao, You An Men Wai, Fengtai District, Beijing, 100069, People's Republic of China.
Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, People's Republic of China.
J Orthop Surg Res. 2022 May 7;17(1):258. doi: 10.1186/s13018-022-03142-0.
Studies have given some pieces of evidence for the effect of total knee arthroplasty (TKA) on knee proprioception of patients with knee osteoarthritis (KOA), but their results were conflicting. This review was performed to provide an updated evidence-based meta-analysis investigating the influence of TKA on knee proprioception.
The electronic databases including PubMed, Google Scholar, and the Cochrane Library were accessed from their inception to March 2020. Two reviewers identified the studies that met the selection criteria for this review. Information on study type, participants, follow-up time, and outcome measures was extracted. Methodological quality was independently assessed by two reviewers using the Cochrane Handbook 5.1.0. Eleven studies with 475 participants were included in the meta-analysis.
The I index assessed the heterogeneity between studies. The results showed that the pooled standard mean difference of mean angle of error was - 0.58° (95% CI - 1 to - 0.16; P = 0.007; I = 69%), and the joint position sense of KOA patients was better after TKA surgery than that before surgery. Pooled standard mean difference of displacement of center of pressure (COP) was - 0.39 (95% CI - 0.72 to - 0.06; P = 0.02; I = 51%), and KOA patients had better static balance after TKA surgery than before surgery.
To conclude, no standardized comprehensive evaluation protocol presently exists though different assessment tools are available to measure proprioception. Contrasting results were found in the literature since some studies found that TKA improves proprioception in KOA patients, while others found no difference in proprioception. These differences are seen whether the proprioception was assessed by joint position sense (JPS), or it was indirectly assessed by static balance. However, the lack of sufficient data on the threshold to detect passive movement (TTDPM) and dynamic balance made it difficult to draw a conclusion about whether or not the sense of motion improved after surgery. The method for measuring and evaluating knee joint force sense is worth paying attention, which will make progress with knee proprioception on TKA patients.
已有研究为全膝关节置换术（TKA）对膝骨关节炎（KOA）患者膝关节本体感觉的影响提供了一些证据，但结果存在争议。本综述旨在提供一项更新的基于证据的荟萃分析，以调查 TKA 对膝关节本体感觉的影响。
从建库起至 2020 年 3 月，检索了电子数据库，包括 PubMed、Google Scholar 和 Cochrane Library。两位评审员确定了符合本综述选择标准的研究。提取了研究类型、参与者、随访时间和结局测量的信息。两位评审员使用 Cochrane 手册 5.1.0 独立评估了方法学质量。Meta 分析共纳入了 11 项研究，共 475 名参与者。
I 指数评估了研究之间的异质性。结果显示，平均误差角度的合并标准均数差为-0.58°（95% CI -1 至-0.16；P=0.007；I=69%），KOA 患者在 TKA 手术后的关节位置感优于手术前。中心压力位移（COP）的合并标准均数差为-0.39（95% CI -0.72 至-0.06；P=0.02；I=51%），KOA 患者在 TKA 手术后的静态平衡优于手术前。
目前尚无标准化的综合评估方案，尽管有不同的评估工具可用于测量本体感觉。文献中发现了对比结果，因为一些研究发现 TKA 改善了 KOA 患者的本体感觉，而另一些研究则发现本体感觉没有差异。这些差异无论是通过关节位置感觉（JPS）评估，还是通过静态平衡间接评估，都存在。然而，由于缺乏关于被动运动阈值（TTDPM）和动态平衡的足够数据，很难得出手术后运动感觉是否改善的结论。测量和评估膝关节力感觉的方法值得关注，这将有助于 TKA 患者的膝关节本体感觉的进步。
