In the JournalsPerspective

Meta-analysis finds initial walking speed positively impacted by knee arthroplasty

Knee arthroplasty helped increase patients’ walking speed at 6 months to 60 months postoperatively, according to a study conducted by researchers in The Netherlands.

“Test-retest reliability of walking speed measurements is high, and when the same investigators monitor the same subjects, it should be possible to assess the walking speed effects of knee arthroplasty,” the authors wrote in the study abstract. “The present study reports a meta-analysis of these effects.”

For the analysis, the authors looked through 16 independent comparisons of preoperative and postoperative walking speed for patients who underwent knee arthroplasty. They identified 12 studies in their survey of Medline, Web of Science, and PEDro, for a total of 419 patients.

The authors wrote, “For 0.5 months to 5 months postoperatively, heterogeneity was too large to obtain a valid estimate of the overall effect-size. For 6 months to 12 months and 13 months to 60 months postoperatively, heterogeneity was absent, low or moderate (depending on estimated pre-post correlations).”

During the 6-month to 12-month and the 13-month to 60-month periods, patients in the study experienced an average speed increase of 0.8 standard deviations. Further analysis, however, suggested initial improvements in speed would be followed by a decline, the authors noted.

Knee arthroplasty helped increase patients’ walking speed at 6 months to 60 months postoperatively, according to a study conducted by researchers in The Netherlands.

“Test-retest reliability of walking speed measurements is high, and when the same investigators monitor the same subjects, it should be possible to assess the walking speed effects of knee arthroplasty,” the authors wrote in the study abstract. “The present study reports a meta-analysis of these effects.”

For the analysis, the authors looked through 16 independent comparisons of preoperative and postoperative walking speed for patients who underwent knee arthroplasty. They identified 12 studies in their survey of Medline, Web of Science, and PEDro, for a total of 419 patients.

The authors wrote, “For 0.5 months to 5 months postoperatively, heterogeneity was too large to obtain a valid estimate of the overall effect-size. For 6 months to 12 months and 13 months to 60 months postoperatively, heterogeneity was absent, low or moderate (depending on estimated pre-post correlations).”

During the 6-month to 12-month and the 13-month to 60-month periods, patients in the study experienced an average speed increase of 0.8 standard deviations. Further analysis, however, suggested initial improvements in speed would be followed by a decline, the authors noted.

    Perspective

    The article by Abbasi-Bafghi and colleagues unravels yet another attribute of total knee arthroplasty (TKA) in restoring function to our patients and alleviating their pain. The investigators, by conducting a meta-analysis of 16 published articles, have found that TKA improves walking speed of patients at 6 months to 12 months. As a knee surgeon, this is one aspect of function that I have so far been failing to discuss with my patients. Having read this well-written article, I will be sure to include this in future discussions.

    The reason for improved walking speed of these patients, though multifactorial, in my opinion relates directly to alleviation of pain that is experienced after knee replacement. It is not surprising, though it is reassuring to see, why the walking speed and other functional parameters improve once the chronic arthritis with the underlying stiffness is removed and the near-normal biomechanical milieu is restored to the joint.

    The meta-analysis is well executed and the findings can be relied upon for future discussions with patients. However, like any meta-analysis, there are some shortcomings of this study — most important of which relates to the fact that there were not many level 1 studies on the subject. The findings are compelling enough to persuade us to design relevant studies to investigate this interesting aspect of functional recovery of patients undergoing TKA.

    • Javad Parvizi, MD
    • Rothman Institute Philadelphia

      Orthopedics Today Editorial Board member

    Disclosures: Parvizi is a consultant to Zimmer, Smith and Nephew, 3M and Convatec.