Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach Exercise Improves Early Functional Recovery After Total Hip Arthroplasty Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. Improving pain management after total joint replacement surgery. Patient expectations of arthroplasty of the hip and knee. Objective functional assessment of total hip arthroplasty following two common surgical approaches: The posterior and direct lateral approaches A randomized controlled trial of exercise to improve mobility and function after elective knee arthroplasty. Feasibility, results and methodological difficulties Patient and intraoperative factors influencing satisfaction two to five years after primary total knee arthroplasty. Robot‐assisted total hip arthroplasty: Clinical outcomes and complication rate Preoperative predictors of pain following total knee arthroplasty. Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: A single-blind randomized controlled trial.
Purpose Despite reduction in radiological outliers in previous r and omized trials comparing robotic-assisted versus conventional total knee arthroplasty ( TKA ) , no differences in short-term functional outcomes were observed . The aim of this study was to determine whether there was improvement in functional outcomes and quality -of-life ( QoL ) measures between robotic-assisted and conventional TKA . Methods All 60 knees ( 31 robotic-assisted ; 29 conventional ) from a previous r and omized trial were available for analysis . Differences in range of motion , Knee Society ( KSS ) knee and function scores , Oxford Knee scores ( OKS ) , SF-36 subscale and summative ( physical PCS/mental component scores MCS ) were analysed . In addition , patient satisfaction , fulfilment of expectations and the proportion attaining a minimum clinical ly important difference ( MCID ) in KSS , OKS and SF-36 were studied . Results Both robotic-assisted and conventional TKA displayed significant improvements in majority of the functional outcome scores at 2 years . Despite having a higher rate of complications , the robotic-assisted group displayed a trend towards higher scores in SF-36 QoL measures , with significant differences in SF-36 vitality ( p = 0.03 ) , role emotional ( p = 0.02 ) and a larger proportion of patients achieving SF-36 vitality MCID ( 48.4 vs 13.8 % , p = 0.009 ) . No significant differences in KSS , OKS or satisfaction/expectation rates were noted . ConclusionS ubtle improvements in patient QoL measures were observed in robotic-assisted TKA when compared to conventional TKA . This finding suggests that QoL measures may be more sensitive and clinical ly important than surgeon-driven objective scores in detecting subtle functional improvements in  robotic-assisted TKA  patients .Level of evidence II OBJECTIVE To quantify the magnitude of change seen with pain , function , and quality of life outcomes 6 months after  total hip and knee arthroplasties ( THA , TKA )  within a community based cohort of a regional health district . METHODS An inception cohort of 504 patients who received primary THA ( 228 ) or TKA ( 276 ) was prospect ively followed . All patients resided in the community and were assessed within one month prior to surgery and 6 months postoperatively . Health related quality of life measures were evaluated with the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index and the Medical Outcome Survey Short Form SF-36 . Perioperative factors were extracted from medical charts . Health services utilization data were collected from regional health data bases . RESULTS Over 75 % of patients reported improvement in joint-specific pain and function , regardless of the type of joint replaced . Other health dimensions such as social function , bodily pain , physical function , vitality , and general health showed significant improvement after surgery . Those psychosocial dimensions with modest changes had baseline values comparable to age and sex adjusted normal values ; whereas , bodily pain and physical function , which had large changes , had values lower than the normal values . Ninety-one percent of patients receiving THA were satisfied with their surgery , whereas 77 % were satisfied with their TKA . The average length of stay was 7 days and the in-hospital complication rate was 0.34 per patient . CONCLUSION Large improvements were reported for pain and function after joint arthroplasties , while small to moderate changes were seen in other areas related to quality of life .  Patients with hip arthroplasties showed greater improvement in pain and function and were more satisfied with their outcomes than patients with knee arthroplasties . Although pain and function show large improvements , bodily pain and physical function were less than the values reported in the general population OBJECTIVE To evaluate the relationship between patient expectations of  total joint arthroplasty ( TJA ) and health related quality of life plus satisfaction 6 months after surgery . Methods . This prospect i ve cohort study included patients undergoing primary total hip ( THA ) and knee arthroplasty ( TKA ) .  Patients were evaluated with  self-report question naires prior to surgery and 6 months post-surgery . Medical Outcomes Study Short Form 36 ( SF-36 ) , the Western Ontario McMaster Universities Osteoarthritis Index ( WOMAC ) , and a satisfaction scale were used to evaluate outcomes at final followup . Multivariate regression models were used to evaluate the impact of expectations on outcomes . RESULTS There were 102 patients with THA and 89 with TKA . Mean age was 66 years . All patients achieved significant improvements in their WOMAC and SF-36 scores following surgery . Patient expectations regarding surgery were not associated with their age , gender , index joint of surgery , marital status , or race . Expectations were not correlated with pre-operative functional health status . Expectation of complete pain relief after surgery was an independent predictor of better physical function and improvement in level of pain at 6 months post-surgery . Expectation of low risk of complications from TJA was an independent predictor of greater satisfaction . CONCLUSIONS Patient expectations were important independent predictors of improved functional outcomes and satisfaction following TJA . Greater underst and ing of the relationship between expectations and outcomes may improve the process of care and outcomes of TJA OBJECTIVE To evaluate the effect of a short preoperative exercise intervention on the functional status , pain , and muscle strength of patients before and after total joint arthroplasty . METHODS A total of 108 men and women scheduled for total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) were r and omized to a 6-week exercise or education ( control ) intervention immediately prior to surgery . We assessed outcomes through question naires and performance measures . Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery . RESULTS Among THA patients , the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score ( improvement of 2.2 in exercisers versus decline of 3.9 in controls ; P = 0.02 ) and Short Form 36 physical function score ( decline of 0.4 in exercisers versus decline of 14.3 in controls ; P = 0.003 ) . No significant differences were seen in TKA patients . Exercise participation increased muscle strength preoperatively ( 18 % in THA patients and 20 % in TKA patients ) , whereas the control patients had essentially no change in strength ( P > 0.05 for exercise versus education in both THA and TKA groups ) . Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients ( adjusted odds ratio 0.27 , 95 % confidence interval 0.074 - 0.998 ) . The intervention had no effects on outcomes 8 and 26 weeks postoperatively . CONCLUSION A 6-week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA . Additionally , exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation Background and purpose — Criticism of the lateral approach ( LA ) for hip arthroplasty is mainly based on the risk of poor patient-reported outcomes compared to the posterior approach ( PA ) . However , there have been no controlled studies comparing patient-reported outcomes between them . In this r and omized controlled trial , we tested the hypothesis that patient-reported outcomes are better in patients who have undergone total hip arthroplasty ( THA ) with PA  than in those who have undergone THA with LA , 12 months postoperatively . Patients and methods — 80 patients with hip osteoarthritis ( mean age 61 years ) were r and omized to THA  using  PA or the modified direct LA . We recorded outcome measures preoperatively and 3 , 6 , and 12 months postoperatively using the Hip Disability and Osteoarthritis Outcome Score – Physical Function Short Form ( HOOS-PS ) as the primary outcome . Secondary outcomes were HOOS-Pain , HOOS- Quality -Of-Life , EQ-5D , UCLA Activity Score , and limping . Results — We found no statistically significant difference in the improvements in HOOS-PS between the treatment groups at 12-month follow-up . All secondary outcomes showed similar results except for limping , where PA patients improved significantly more than LA patients . Interpretation — Contrary to our hypothesis , patients treated with PA did not improve more than patients treated with LA regarding physical function , pain , physical activity , and quality of life 12 months postoperatively . However , limping was more pronounced in the LA patients The purpose of this prospect i ve , r and omized study was to apply an 8-week customized exercise program to patients ( Group E ) scheduled for total hip arthroplasty , followed by a postsurgery exercise program , and show the effect on functional recovery compared with control subjects ( Group C ) who received no additional exercise apart from routine in-hospital physical therapy .  Strength , range of motion , and physical function tests were completed by 57 patients at Week 8 and Week 1 before surgery and at Weeks 3 , 12 , and 24 postoperatively . No differences between the exercise and control groups were observed at baseline . By 1 week before surgery , patients in Group E had shown significant improvements for Western Ontario and McMaster Universities Osteoarthritis Index ( total score , stiffness , and physical function components ) , and combined hip strength . Patients in Group E had improved hip flexion range of motion in the diseased hip compared with patients in Group C. Significant differences in outcome measures between Group E and Group C were observed throughout the postoperative phase from Weeks 3 to 24 . The current study showed that customized perioperative exercise programs are well tolerated by patients with end-stage hip arthritis , and are effective in improving early recovery of physical function after total hip arthroplasty In this prospect i ve r and omized study , patients undergoing total hip ( THA ) or knee arthroplasty ( TKA ) were r and omized to either a study group receiving periarticular injections or a control group receiving patient-controlled analgesia with or without femoral nerve block ( TKA patients ) . All patients received a comprehensive multimodal perioperative protocol .  Pain , recovery of functional milestones , and overall satisfaction were assessed . The THA study group demonstrated significantly lower average pain scores and higher overall satisfaction than the control group . There was no significant difference in pain scores between the study and control groups in the TKA cohort . Both study groups demonstrated lower narcotic usage and side effects as well as improved early functional recovery . Periarticular injection with a multimodal protocol was shown to safely provide excellent pain control and functional recovery and can be substituted for conventional pain control modalities Background Hip replacement ( arthroplasty ) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint . For older patients , several design s of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money . However , in younger more active patients , there is approximately a 50 % failure rate at 25 years for traditional implants . Hip resurfacing is a relatively new arthroplasty technique . In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified , including the risk of femoral neck fracture and collapse of the head of the femur . The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty . Secondary aims include assessment of complication rates for both procedures as well cost effectiveness . Methods / design All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study . A r and omisation sequence will be produced and administered independently . After consenting , all patients will be clinical ly review ed and hip function , quality of life and physical activity level will be assessed through question naires . The allocated surgery will then be performed with the preferred technique of the surgeon . Six weeks post-operation hip function will be assessed and complications recorded . Three , six and 12 months post-operation hip function , quality of life and physical activity level will be assessed . Additional information about patients ' out-of-pocket expenses will also be collected . Trial registration Current Controlled Trials IS RCT N33354155UKCLRN portfolio ID OBJECTIVE The purpose of this study was to examine the effect of a preoperative exercise intervention on knee pain , functional ability , and quadriceps strength among patients with knee osteoarthritis before and after total knee arthroplasty ( TKA ) surgery . DESIGN A repeated- measures design was used to compare 2 groups over 4 data collection points . SETTING AND PATIENTS Community-dwelling subjects with osteoarthritis of the knee who were scheduled for a unilateral TKA were recruited from a single orthopedic surgeon 's office and were r and omized into control ( n = 28 ) or prehab groups ( n = 26 ) . INTERVENTIONS The control patients maintained usual care before their TKA . The exercisers performed prehabilitation exercises , which included resistance training , flexibility , and step training , 3 times per week before their TKA . OUTCOME MEASURES Knee pain , functional ability , quadriceps strength , and strength asymmetry were assessed at baseline ( T1 ) , at 1 week before the patients ' TKA ( T2 ) , and again at 1 ( T3 ) and 3 ( T4 ) months after TKA . RESULTS The exercisers improved their sit-to-st and performance at T2 , whereas the control group did not change their performance of functional tasks and had increased pain at T2 . At T3 the exercisers demonstrated improved sit-to-st and performance . The control patients at T3 exhibited decreases in pain , their 6-minute walk , surgical leg strength and an increase in their nonsurgical leg strength and leg strength asymmetry . At T4 the exercisers improved in their performance of 3 of the 4 functional tasks , decreased all of their pain measures , and increased their surgical and nonsurgical quadriceps strength . At T4 the control group improved their performance on 2 of the 4 functional tasks , decreased all of their pain measures , increased their nonsurgical leg strength , and exhibited greater leg strength asymmetry . CONCLUSION These findings appear to indicate the efficacy of prehabilitation among TKA patients and support the theory of prehabilitation PURPOSE To test the effects of implementing evidence -based postoperative pain management content and strategies on patient , provider ( nurse and physician ) , and fiscal outcomes . SAMPLE 118 patients , 57 before and 61 after implementation , having total knee replacement ( TKR ) ( 54 % ) and total hip replacement ( THR ) ( 45 % ) , and 28 orthopaedic nurses . METHODS A research utilization approach with a pretest/posttest design was used . Independent variables ( interventions ) included evidence -based pain management content , education of care providers and patients , and system changes at the point of care . Dependent variables ( outcomes ) were patient perception of the postoperative pain experience , provider practice patterns , and length of stay ( LOS ) . FINDINGS The hypotheses of decreased provider use of meperidine and increased use of hydromorphone , i.v . route , pain plans of care , and nurse knowledge were supported . LOS was significantly reduced . The patient hypotheses decreased pain intensity and side effects and increased satisfaction and function were not supported . CONCLUSION Method ical implementation of evidence -based pain management information changed practice and fiscal outcomes . Improvement in the patient perception of pain management was more difficult to achieve Patient expectations and their fulfilment are an important factor in determining patient-reported outcome and satisfaction of  hip ( THR ) and knee replacement ( TKR ) . The aim of this prospect i ve cohort study was to examine the expectations of patients undergoing THR and TKR  , and to identify differences in expectations , predictors of high expectations and the relationship between the fulfilment of expectations and patient-reported outcome measures . During the study period , patients who underwent 346 THRs and 323 TKRs  completed an expectation question naire , Oxford score  and  Short-Form 12 ( SF-12 ) score pre-operatively . At one year post-operatively , the Oxford score , SF-12 , patient satisfaction and expectation fulfilment were assessed . Univariable and multivariable analysis were performed . Improvements in mobility and daytime pain were the most important expectations in both groups . Expectation level did not differ between THR and TKR . Poor Oxford score , younger age and male gender significantly predicted high pre-operative expectations ( p < 0.001 ) . The level of pre-operative expectation was not significantly associated with the fulfilment of expectations or outcome . THR better met the expectations identified as important by patients . TKR failed to meet expectations of kneeling , squatting and stair climbing . High fulfilment of expectation in both THR and TKR was significantly predicted by young age , greater improvements in Oxford score and high pre-operative mental health scores . The fulfilment of expectations was highly correlated with satisfaction Abstract Despite the high number of total hip arthroplasty ( THA )  procedures performed each year , there is no common consensus on the best surgical approach . Gait is known to improve following THA although it does not return to what is typically quantified as normal , and surgical approach is believed to be a contributing factor . The current study evaluates post-operative hip function  and provides an objective assessment following two common surgical approaches : the McFarl and —Osborne direct lateral and the southern posterior .  Faced with the common problem of providing an objective comparison from the wealth of data collected using motion analysis techniques , the current study investigates the application of an objective classification tool to provide information on the effectiveness of each surgery and to differentiate between the characteristics of hip function following the two approaches . Seven inputs for the classifier were determined through statistical analysis of the biomechanical data . The posterior approach group exhibited greater characteristics of non-pathological gait and displayed a greater range of functional ability as compared with the lateral approach cohort . The classification tool has proved to be successful in characterizing non-pathological and THA function but was insufficient in distinguishing between the two surgical cohorts Objective : To assess the feasibility of comparing two types of exercise regime aim ing to improve mobility and function following knee arthroplasty . Design : A single-blind r and omized controlled trial . Subjects : Patients with primary , unilateral knee osteoarthritis undergoing elective knee joint replacement . Intervention : Home-based traditional exercise group ( TEG ) or home-based functional exercise group ( FEG ) following discharge from hospital . Outcome measures : These included goniometry ; a knee-specific pain score , leg extensor power and a walking test . Patients were followed up at three , six and 12 months after surgery . Results : Forty-seven patients met the study criteria , 24 were r and omized to the TEG and 23 to the FEG .  There were marked improvements in mobility , leg extensor power and pain in the year after surgery ( MANOVA p < 0.001 ) . There were no statistically significant differences between the two exercise groups . Knee flexion decreased during the follow-up period and had not recovered by 12 months . Retention of patients was a problem , with nearly 50 % lost to follow-up at 12 months . These patients were assessed as having low motivation during inpatient rehabilitation ( p < 0.05 ) . Conclusions : There were trends in favour of the FEG that were of clinical relevance . A definitive study would need a sample size of at least 100 patients in each arm . It is essential to develop strategies to combat loss to follow-up The purpose of this study was to compare patient demographics and factors recorded at the time of surgery between patients that were either satisfied or dissatisfied with their TKA at mid-term follow-up . From our prospect i ve outcomes data base , 989 primary TKAs with complete preoperative and intraoperative data were identified . At mean follow-up of 3.5 years , 94/989 TKAs ( 9.5 % ) were not satisfied with their TKA . African American patients were 3.0 times more likely to be dissatisfied than Caucasians ( 95 % CI = 1.5 - 6.0 , P = .003 ) . Patients with less severe degenerative changes  were 2.1 times more likely to be dissatisfied ( 95 % CI = 1.3 - 3.2 , P = .001 ) BACKGROUND The purpose of this study was to report minimum 2-year outcomes and complications for robotic-arm-assisted total hip arthroplasty ( THA )  . METHODS Data were prospect ively collected and retrospectively review ed between June 2011 and April 2014 . Inclusion criteria were primary robotic-arm-assisted THAs treating idiopathic osteoarthritis with ≥ 2-year follow-up .  Demographics , operating time , complications , 2-year outcome scores and satisfaction , and subsequent surgeries were recorded . RESULTS There were 181 cases eligible for inclusion , of which 162 ( 89.5 % ) had minimum 2-year follow-up . At the latest follow-up , the mean visual analogue scale was 0.7 , satisfaction was 9.3 , Harris hip score was 91.1 and forgotten joint score was 83.1 . Six ( 3.7 % ) intraoperative complications and six ( 3.7 % ) postoperative complications were reported . No leg length discrepancies ( LLDs ) or dislocations were reported . CONCLUSIONS Robotic-arm-assisted THA demonstrates favourable short-term outcomes and does not result in a higher complication rate compared to non-robotic THA as reported by the literature Total knee arthroplasty has provided dramatic improvements in function and pain for the majority of patients with knee arthritis , yet a significant proportion of patients remain dissatisfied with their results . We performed a prospect i ve analysis of 215 patients undergoing TKA who underwent a comprehensive array of evaluations to discover whether any preoperative assessment could predict high pain scores and functional limitations postoperatively . Patients with severe pain with a simple knee range-of-motion test prior to TKA had a 10 times higher likelihood of moderate to severe pain at 6 months . A simple test of pain intensity with active flexion and extension preoperatively was a significant predictor of postoperative pain at 6 months after surgery . Strategies to address this particular patient group may improve satisfaction rates of TKA OBJECTIVE To evaluate the effectiveness of a new intensive functional rehabilitation ( IFR ) program on functional ability and quality of life ( QOL ) in persons who underwent a first total knee arthroplasty ( TKA ) . DESIGN R and omized controlled trial . SETTING Ambulatory care . PARTICIPANTS Seventy-seven people with knee osteoarthritis . INTERVENTION Two months after TKA , subjects were r and omly assigned to either a group with IFR ( n=38 ) , who received 12 supervised rehabilitation sessions combined with exercises at home between months 2 and 4 after TKA , or to a control group ( n=39 ) , who received st and ard care . All participants were evaluated by a blind evaluator at baseline ( 2mo after TKA ) , immediately after IFR ( 2mo later ; POST1 ) , and 2 and 8 months later ( POST2 and POST3 ) . Main outcome measures The primary outcome measure with respect to effectiveness was the 6-minute walk test ( 6MWT ) at POST2 . Secondary outcome measures were the 6MWT at the other evaluations and the Western Ontario and McMaster Universities Osteoarthritis Index and Medical Outcomes Study 36-Item Short-Form Health Survey . RESULTS Subjects in the IFR group walked longer distances ( range , 23 - 26 m ) in 6 minutes at the 3 POST evaluations than subjects in the control group . At POST1 and POST2 , they also had less pain , stiffness , and difficulty in performing daily activities . Positive changes in QOL in favor of the IFR were found only at POST2 . CONCLUSIONS The IFR was effective in improving the short-term and mid-term functional ability after uncomplicated primary TKA . The magnitude of the IFR effect on the primary outcome was modest but consistent . More intensive rehabilitation should be promoted in the subacute recovery period after TKA , to optimize functional outcomes in the first year after surgery
R and om-effects meta-analyses showed that post-operative functional outcomes were comparable between active robotic and conventional total hip and knee arthroplasty at the short- , medium- and long-term follow-up .
Conclusions This systematic and meta-analyses indicates that functional outcomes for patients undergoing active robotic total hip and knee arthroplasty were comparable to conventional surgery .
Whether semi-active or active robotic hip or knee arthroplasty is effective in improving post-operative pain , quality of life and satisfaction with surgery is unclear .
Purpose The purpose of the study is to determine the effectiveness of semi-active and active robotic hip and knee arthroplasty on post-operative patient-reported outcomes of function , pain , quality of life and satisfaction with surgery .