Physical Function After Total Knee Replacement: An Observational Study Describing Outcomes in a Small Group of Women From China and the United States.
Daniel K White, Zhichang Li, Yuqing Zhang and 7 others
PMID 28760574WHAT IT FOUND
At six months, the China group walked farther after knee replacement than the US group, but the difference was not significant.
They began with lower function and improved more in walking.
Key findings
01Before surgery, the China group walked 213 meters in the six-minute walk and completed 3.0 chair stands in 30 seconds, compared with 398.7 meters and 11.3 chair stands in the US group.
02Six months after surgery, the China group walked 542.6 meters and the US group walked 446.8 meters, but the difference did not meet statistical significance.
03Improvement in walking over six months was greater in the China group, while improvement in chair stands was not greater.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study analysed only 30 women in each group and was exploratory. It included only women with unilateral total knee replacement for osteoarthritis, so it says little about men, revision surgery, or other knee conditions. Many participants were lost before follow-up: 16 of 46 in the US group and 14 of 44 in the China group. The groups were not randomised to country or rehabilitation system, and they differed before surgery in walking and chair-stand performance. Rehabilitation was bundled and different between countries, so the effect of any single component cannot be separated. The analysis adjusted only for age, BMI, and comorbidity; education, osteoarthritis severity, and pre-surgical knee pain were not available. The China group was all retired and had more hypertension and cardiovascular disease than the US group.
Declared interests
The paper is listed as supported by NIH extramural research. No author financial conflicts are reported in the supplied text.
The easy way to misread this
Do not conclude that Chinese rehabilitation produces better knee replacement function. The six-month walking difference was not significant, the groups started with very different function, and the study was small and observational. The contribution of any single rehabilitation component cannot be separated.