Total Knee Arthroplasty in Patients with Knee Osteoarthritis: Effects on Proprioception. A Systematic Review and Best Evidence Synthesis

Abstract Background Impact of total knee arthroplasty (TKA) on proprioception remains to be determined. The aim of this systematic review is to analyze factors influencing proprioception in patients with knee osteoarthritis (OA) undergoing TKA. Methods A systematic literature search was conducted on 3 medical electronic databases: PubMed, PeDRO, and Cochrane Collaboration. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used. Risk of bias analysis and best evidence synthesis were performed. Three main aspects were investigated: the presence of preoperative, surgical, and postoperative factors influencing proprioception in OA patients undergoing TKA. Results Search identified 1601 records. After screening, 19 papers were used for the analysis of 676 patients. Proprioception generally improved but often remained impaired after surgery. Strong evidence was found for no influence of prosthesis design on proprioception. Moderate evidence was found for patellar resurfacing not affecting proprioception, varus deformity negatively influencing proprioception, and time elapsed from surgery positively influencing proprioception. Limited evidence was found for valgus deformity, OA grade, intact anterior cruciate ligament, and anteroposterior joint laxity negatively affecting knee proprioception, and for muscle strength and sensorimotor training not affecting proprioception. Finally, conflicting evidence was found for better postoperative proprioception vs preoperative level. Conclusion Proprioception in OA patients undergoing TKA improves but remains impaired after surgery. The best evidence synthesis demonstrated no influence of prosthetic design, while the role of the treatment remains unclear. This warrants for further research efforts to study proprioceptive impairment to better manage OA patients undergoing TKA.