Virtual reality-based rehabilitation in patients following total knee arthroplasty:a systematic review and meta-analysis of randomized controlled trials

Background:Physical therapy is regarded as an essential aspect in achieving optimal outcomes following total knee arthroplasty(TKA).The coronavirus disease 2019(COVID-19)pandemic has made face-to-face rehabilitation inaccessible.Virtual reality(VR)is increasingly regarded as a potentially effective option for offering health care interventions.This systematic review and meta-analysis investigate VR-based rehabilitation's effectiveness on outcomes following TKA.Methods:From inception to May 22,2021,PubMed/Medline,Embase,Web of Science,the Cochrane Central Register of Controlled Trials,Scopus,PsycINFO,Physiotherapy Evidence Database,China National Knowledge Infrastructure,and Wanfang were comprehensively searched to identify randomized controlled trials(RCTs)evaluating the effect of VR-based rehabilitation on patients following TKA according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions.Results:Eight studies were included in the systematic review,and seven studies were included in the meta-analysis.VR-based rehabilitation significantly improved visual analog scale(VAS)scores within 1 month(standardized mean difference[SMD]:−0.44;95%confidence interval[CI]:−0.79 to−0.08,P=0.02),the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)within 1 month(SMD:−0.71;95%CI:−1.03 to−0.40,P<0.01),and the Hospital for Special Surgery Knee Score(HSS)within 1 month and between 2 months and 3 months(MD:7.62;95%CI:5.77 to 9.47,P<0.01;MD:10.15;95%CI:8.03 to 12.27,P<0.01;respectively)following TKA compared to conventional rehabilitation.No significant difference was found in terms of the Timed Up and Go(TUG)test.Conclusions:VR-based rehabilitation improved pain and function but not postural control following TKA compared to conventional rehabilitation.More high-quality RCTs are needed to prove the advantage of VR-based rehabilitation.As the COVID-19 pandemic continues,it is necessary to promote this rehabilitation model.

Influence of patellofemoral joint degeneration on clinical outcomes after medial unicompartmental knee arthroplasty

Background:Patellofemoral joint(PFJ)degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty(UKA).More recently,some researchers have proposed that PFJ degeneration can be ignored in medial UKA,and others have proposed that this change should be reviewed in PFJ degenerative facets and severity.This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures(PROMs)and revision rates after medial UKA.Methods:Electronic databases(PubMed,Embase,Web of Science,etc.)were searched for studies assessing the influence of PFJ degeneration on medial UKA.A random-effects meta-analysis was conducted for the Oxford knee score(OKS),Knee society score(KSS),and revision rates and stratified by PFJ degenerative facets(medial/lateral/trochlear/unspecified),severe PFJ degeneration(bone exposed),and bearing type(mobile/fixed).Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.Results:A total of 34 articles with 7007 knees(2267 with PFJ degeneration)were included(5762 mobile-bearing and 1145 fixed-bearing and 100 unspecified).Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS,and only lateral facets significantly decreased the OKS(mean difference[MD]=-2.18,P<0.01)and KSS(MD=-2.61,P<0.01).The severity degree of PFJ degeneration had no additional adverse effect on the OKS,KSS,or revision rates.For mobile-bearing UKA,only lateral PFJ degeneration significantly decreased the OKS(MD=-2.21,P<0.01)and KSS(MD=-2.44,P<0.01).For fixed-bearing UKA,no correlation was found between PROMs/revision rates and PFJ degeneration.Conclusion:For medial mobile-bearing UKA,slight to moderate degenerative changes in the PFJ,except lateral facet,did not compromise PROMs or revision rates.For medial fixed-bearing UKA,although it might not be conclusive enough,PROMs or revision rates were not adversely affected by PFJ degeneration(regardless of the facet).

Trajectory and predictors of cartilage damage in three compartments of the knees at risk for osteoarthritis

To the Editor:Osteoarthritis(OA)is a prominent disabling disease characterized by progressive articular cartilage damage coupled with deterioration in the subchondral bone and other structures of the joint,and is ranked as the 12th highest disease contributing to global disability.[1]The course of knee OA is considerably long and can affect three knee compartments(the patellofemoral joint[PFJ],medial tibiofemoral joint[MTFJ],and lateral tibiofemoral joint[LTFJ])alone or in combination,resulting in a large variation in the occurrence of cartilage damage in the three compartments.[2]We aimed to determine the baseline predictors associated with distinct tricompartmental trajectories of cartilage damage in knees at risk for OA.