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The Functional Outcomes of Total Knee Arthroplasty
Robert L. Kane, MD1; Khaled J. Saleh, MD, MSc, FRCSC2; Timothy J. Wilt, MD, MPH3; Boris Bershadsky, PhD1
1 University of Minnesota School of Public Health, D351 Mayo (MMC 197), 420 Delaware Street S.E., Minneapolis, MN 55455. E-mail address for R.L. Kane: kanex001@umn.edu
2 Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA 22903. E-mail address: saleh@virginia.edu
3 VA Medical Center, General Internal Medicine (111-0), One Veterans Drive, Minneapolis, MN 55417. E-mail address: tim.wilt@med.va.gov
View Disclosures and Other Information
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Agency for Healthcare Research and Quality. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (Stryker Orthopaedics and Smith and Nephew) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Minnesota Evidence-Based Practice Center, University of Minnesota Clinical Outcomes Research Center, and Minneapolis VA Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Aug 01;87(8):1719-1724. doi: 10.2106/JBJS.D.02714
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Background: As an elective procedure, total knee arthroplasty is under scrutiny to evaluate its cost-effectiveness. In this review, we examined the available literature on total knee arthroplasty to assess the evidence regarding factors associated with better functional outcomes.

Methods: A structured literature search of English-language databases was performed to identify studies of the functional outcomes of total knee arthroplasty that had been published between 1995 and April 2003. Inclusion criteria were a study of primary total knee arthroplasty, more than 100 knees in the study, provision of baseline data and rating of postoperative outcomes with a standardized symptom scale, and an experimental or quasi-experimental study design. The abstracting form included a list of potential prognostic factors, including comorbidities, radiographic evidence of joint destruction, bone loss, integrity of the extensor mechanism, range of motion, alignment, tibiofemoral angle, and ligament integrity, as well as the characteristics of the operating surgeon, such as procedure volume and experience.

Results: Sixty-two studies met the criteria and were reviewed. Total knee arthroplasty was found to be associated with substantial functional improvement, with the effect sizes varying with the measure that was used. Physician-derived measures showed effect sizes of 2.35 and 3.91, whereas patient-derived measures showed smaller effect sizes (1.27 and 1.62). Few investigators used multivariate models to identify associations between outcomes and patient characteristics.

Conclusions: Total knee arthroplasty is a generally effective procedure, but the current English-language literature does not support specific recommendations about which patients are most likely to benefit from it.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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