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Surgery and joint replacement

TL;DR — An individualized PROM-based decision aid did not significantly change one-year outcomes in one trial; mean dissatisfaction after total knee arthroplasty was 10% in a systematic review, and prehabilitation evidence was low strength and heterogeneous (Marshall 2023, PMID 36575631; DeFrance 2023, PMID 36252743; Konnyu 2023, PMID 35302954).

Decision frame

This page was audited against 30 live-refetched PubMed records on 2026-08-31. It distinguishes evidence about diagnosis or symptoms from evidence about structure and does not treat association as proof of treatment effect.

Audit interpretation safeguards

  • A title establishes what a record studied, not the truth of every topic-adjacent statement.
  • Numerical results are used only when present in the live-fetched abstract or the cited report.
  • Association is not treated as treatment effect, and a protocol is not treated as a completed trial.
  • Systematic reviews inherit heterogeneity in population, intervention, comparator and outcome definition.

Selection

Domain What the evidence supports What remains uncertain
Decision aid In a randomized trial, an individualized PROM-based decision aid produced no significant one-year differences in expectations, regret, satisfaction, quality of life or depression. (Marshall 2023, PMID 36575631) The study did not exclude benefit from deploying the aid earlier in care.

Outcomes and surveillance

Domain What the evidence supports What remains uncertain
Dissatisfaction A systematic review estimated mean dissatisfaction after total knee arthroplasty at 10%; persistent pain, stiffness, complications and unmet expectations were common reasons. (DeFrance 2023, PMID 36252743) Dissatisfaction is not identical to chronic postsurgical pain.
Prehabilitation Before knee arthroplasty, prehabilitation may improve strength and shorten stay but was comparable for pain, range of motion and activities of daily living; evidence was low strength. (Konnyu 2023, PMID 35302954) Hip-arthroplasty outcomes had insufficient evidence.

The randomized trade-off is large benefit plus more harm

Skou 2015 (n=100 surgery-eligible moderate-to-severe knee OA): TKR plus nonsurgical care improved KOOS4 by 32.5 vs 16.0 points (adjusted difference 15.8, 95% CI 10.0–21.5) at 12 months; serious adverse events 24 vs 6 (P=0.005); 13/50 (26%) assigned nonsurgical care had TKR by 12 months (Skou 2015, PMID 26488691). Frydendal 2024 is the hip analogue in already-indicated disease: Oxford Hip Score +11.4 (8.9–14.0) vs resistance training at 6 months, 21% crossover from training to THR (Frydendal 2024, PMID 39476341). NICE: refer when symptoms substantially affect quality of life and nonsurgical care is ineffective or unsuitable; do not exclude by age, sex/gender, smoking, comorbidity or BMI (NG226, accessed 2026-08-31).

Partial vs total, revision, dissatisfaction

TOPKAT: no significant 5-year OKS difference, UKA vs TKA (1.04, −0.42 to 2.50), n=528, 88% response (Beard 2020, PMID 32369436; NCT01352247 COMPLETED). Wilson: UKA shorter stay in RCTs (−1.20 days) but 5-year revision RR 5.95 (trials), 2.50 (registries), 3.13 (cohorts) (Wilson 2019, PMID 30792179). In the Dutch registry, 10-year cumulative revision risk after OA arthroplasty ranged from 1.6% to 13% across joint, age, sex and fixation strata, with higher risk at younger ages (Gademan 2021, PMID 33478320). Multinational registry (4.8 million implants): sex-based differences in revision for infection exist and are joint-specific (Roerink 2024, PMID 39656214). Mean TKA dissatisfaction 10% (DeFrance 2023, PMID 36252743); Price emphasizes that ≥20% with poor pain relief in some series is the outcome gap after technically successful implants (Price 2018, PMID 30496082).

Procedures that do not add average benefit

Moseley sham arthroscopy, Kirkley debridement, Sihvonen sham meniscectomy, Katz MeTeOR and Kise exercise-vs-APM are the knee-conserving evidence; NICE does not offer lavage/debridement (see knee OA). Posterior hip precautions: RCT RR 1.8 (0.6–5.2) for early dislocation, NRS 0.9 (0.3–2.5); 8,835 people; low-certainty against routine use (Korfitsen 2023, PMID 37039064). Prehabilitation before TKA/THA: low-strength, may improve strength and shorten stay, comparable for pain/ROM/ADL (Konnyu 2023, PMID 35302954). An online PROM-based decision aid did not change 1-year expectations, regret, satisfaction, QoL or depression (Marshall 2023, PMID 36575631); a separate AI-enabled aid improved decision quality vs education material (Jayakumar 2021, PMID 33599773) — two different tools, not a class effect.

Evidence map

The table catalogs the retrieved studies used to bound this page. A title establishes the paper’s studied question; detailed numerical use requires the abstract or full text.

Study Design signal Evidence contribution Main transfer limit
Marshall 2023 (PMID 36575631) randomized trial Impact of an online, individualised, patient reported outcome measures based patient decision aid on patient expectations, decisiona…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Pacheco-Brousseau 2026 (PMID 41494148) meta-analysis Total and partial knee arthroplasty versus non-surgical interventions of the knee for moderate to severe osteoarthritis. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Cooper 2022 (PMID 35288248) randomized trial Cost-Effectiveness of Closed Incision Negative Pressure Therapy for Surgical Site Management After Revision Total Knee Arthroplasty:…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Chesham 2017 (PMID 27736286) meta-analysis Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthropl…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Faucett 2019 (PMID 29517925) meta-analysis Meniscus Root Repair vs Meniscectomy or Nonoperative Management to Prevent Knee Osteoarthritis After Medial Meniscus Root Tears: Cli…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Hall 2025 (PMID 40111909) systematic review Non-surgical interventions for arthrofibrosis following knee joint replacement: A systematic review. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Konnyu 2023 (PMID 35302955) systematic review Rehabilitation for Total Hip Arthroplasty: A Systematic Review. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Konnyu 2023 (PMID 35302954) systematic review Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Ang 2023 (PMID 37010580) meta-analysis Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and …. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Keogh 2025 (PMID 40298246) systematic review The Effects of Structured Prehabilitation on Postoperative Outcomes Following Total Hip and Total Knee Arthroplasty: An Overview of …. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Shapira 2021 (PMID 32157903) systematic review Outcomes of outpatient total hip arthroplasty: a systematic review. Scope is verified from the live record; numerical transfer requires the abstract or full report.
O'Connor 2022 (PMID 36253795) systematic review Systematic review: preoperative psychological factors and total hip arthroplasty outcomes. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Crompton 2020 (PMID 32718213) systematic review Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Korfitsen 2023 (PMID 37039064) meta-analysis Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence earl…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Zhang 2024 (PMID 38134323) meta-analysis Enhanced recovery after surgery in patients after hip and knee arthroplasty: a systematic review and meta-analysis. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Lewis 2019 (PMID 31060915) meta-analysis Hemiarthroplasty vs Total Hip Arthroplasty for the Management of Displaced Neck of Femur Fractures: A Systematic Review and Meta-Ana…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Loke 2025 (PMID 40380310) meta-analysis MAKO robotic-assisted compared to conventional total hip arthroplasty for hip osteoarthritis: a systematic review and meta-analysis. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Huerfano 2024 (PMID 38619564) meta-analysis Total hip arthroplasty in adolescents: a systematic review and meta-analysis. Scope is verified from the live record; numerical transfer requires the abstract or full report.
DeFrance 2023 (PMID 36252743) systematic review Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Vajapey 2021 (PMID 34026486) journal study Outcomes of total joint arthroplasty in patients with depression: A systematic review. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Riantho 2023 (PMID 37197698) journal study Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Random…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Salman 2023 (PMID 36905418) meta-analysis The outcomes of total hip replacement in osteonecrosis versus osteoarthritis: a systematic review and meta-analysis. Scope is verified from the live record; numerical transfer requires the abstract or full report.
de 2024 (PMID 38766387) review Optimal timing of hip and knee arthroplasty after bariatric surgery: A systematic review. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Dillon 2020 (PMID 33343719) journal study Early revision in anatomic total shoulder arthroplasty in osteoarthritis: a cross-registry comparison. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Roerink 2024 (PMID 39656214) journal study Sex-based differences in risk of revision for infection after hip, knee, shoulder, and ankle arthroplasty in osteoarthritis patients…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Davies 2024 (PMID 38289339) cohort study The risk of revision is higher following shoulder hemiarthroplasty compared with total shoulder arthroplasty for osteoarthritis: a m…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Moran 2021 (PMID 34735461) journal study The risk of revision following total hip arthroplasty in patients with inflammatory bowel disease, a registry based study. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Gademan 2021 (PMID 33478320) journal study Population-based 10-year cumulative revision risks after hip and knee arthroplasty for osteoarthritis to inform patients in clinical…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Fowler 2022 (PMID 35227094) observational study The association between surgeon grade and risk of revision following total hip arthroplasty : an analysis of National Joint Registry…. Scope is verified from the live record; numerical transfer requires the abstract or full report.
Gill 2021 (PMID 34180871) journal study A Comparison of Revision Rates for Osteoarthritis of Primary Reverse Total Shoulder Arthroplasty to Primary Anatomic Shoulder Arthro…. Scope is verified from the live record; numerical transfer requires the abstract or full report.

Audit disposition

Check Result
PubMed identifiers 37/37 unique PMIDs resolved in the 2026-08-31 independent live E-utilities fetch
ClinicalTrials.gov identifiers 1/1 NCT ID resolved and matched in the 2026-08-31 independent v2 API fetch
Author / year / journal Matched to live PubMed metadata; ePub/print offsets tolerated
Claim review Every remaining claim-to-citation pairing was checked against the live-fetched abstract or registry record; unsupported rows were deleted and overbroad claims were narrowed. No substantive citation issue remains.
## Open questions
  • What is the optimal TKA/THA timing strategy among surgery-eligible patients (OQ-8)? Skou and Frydendal quantify 6–12 month benefit, not 10-year net benefit (Skou 2015, PMID 26488691; Frydendal 2024, PMID 39476341).
  • Can preoperative sensitization treatment reduce the persistent-pain fraction after TKA (OQ-9)? (Wluka 2020, PMID 32791103)
  • Are BMI/age/comorbidity cutoffs risk-reduction or inequitable exclusion (OQ-21)? NICE forbids exclusion on those grounds; local thresholds persist.
  • Does UKA's 5-year OKS equivalence survive 10-year revision? (Beard 2020, PMID 32369436; Wilson 2019, PMID 30792179)

References

  1. Marshall DA, Trenaman L, MacDonald KV, et al. Impact of an online, individualised, patient reported outcome measures based patient decision aid on patient expectations, decisional regret, satisfaction, and health-related quality-of-life for patients considering total knee arthroplasty: Results from a randomised controlled trial. J Eval Clin Pract. 2023;29(3);513-524. PMID 36575631
  2. Pacheco-Brousseau L, Abdelrazeq S, Kelly SE, et al. Total and partial knee arthroplasty versus non-surgical interventions of the knee for moderate to severe osteoarthritis. Cochrane Database Syst Rev. 2026;1(1);CD015378. PMID 41494148
  3. Cooper HJ, Bongards C, Silverman RP. Cost-Effectiveness of Closed Incision Negative Pressure Therapy for Surgical Site Management After Revision Total Knee Arthroplasty: Secondary Analysis of a Randomized Clinical Trial. J Arthroplasty. 2022;37(8S);S790-S795. PMID 35288248
  4. Chesham RA, Shanmugam S. Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review. Physiother Theory Pract. 2017;33(1);9-30. PMID 27736286
  5. Faucett SC, Geisler BP, Chahla J, et al. Meniscus Root Repair vs Meniscectomy or Nonoperative Management to Prevent Knee Osteoarthritis After Medial Meniscus Root Tears: Clinical and Economic Effectiveness. Am J Sports Med. 2019;47(3);762-769. PMID 29517925
  6. Hall MC, Smith B, Sheehan KJ, et al. Non-surgical interventions for arthrofibrosis following knee joint replacement: A systematic review. Clin Rehabil. 2025;39(5);580-599. PMID 40111909
  7. Konnyu KJ, Pinto D, Cao W, et al. Rehabilitation for Total Hip Arthroplasty: A Systematic Review. Am J Phys Med Rehabil. 2023;102(1);11-18. PMID 35302955
  8. Konnyu KJ, Thoma LM, Cao W, et al. Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review. Am J Phys Med Rehabil. 2023;102(1);1-10. PMID 35302954
  9. Ang JJM, Onggo JR, Stokes CM, et al. Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023;33(7);2773-2792. PMID 37010580
  10. Keogh JAJ, Keng I, Dhillon DS, et al. The Effects of Structured Prehabilitation on Postoperative Outcomes Following Total Hip and Total Knee Arthroplasty: An Overview of Systematic Reviews and Meta-analyses of Randomized Controlled Trials. J Orthop Sports Phys Ther. 2025;55(5);344-365. PMID 40298246
  11. Shapira J, Chen SL, Rosinsky PJ, et al. Outcomes of outpatient total hip arthroplasty: a systematic review. Hip Int. 2021;31(1);4-11. PMID 32157903
  12. O'Connor JP, Holden P, Gagnier JJ. Systematic review: preoperative psychological factors and total hip arthroplasty outcomes. J Orthop Surg Res. 2022;17(1);457. PMID 36253795
  13. Crompton J, Osagie-Clouard L, Patel A. Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients. Acta Orthop. 2020;91(6);687-692. PMID 32718213
  14. Korfitsen CB, Mikkelsen LR, Mikkelsen ML, et al. Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients. Acta Orthop. 2023;94;141-151. PMID 37039064
  15. Zhang Q, Chen Y, Li Y, et al. Enhanced recovery after surgery in patients after hip and knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J. 2024;100(1181);159-173. PMID 38134323
  16. Lewis DP, Wæver D, Thorninger R, et al. Hemiarthroplasty vs Total Hip Arthroplasty for the Management of Displaced Neck of Femur Fractures: A Systematic Review and Meta-Analysis. J Arthroplasty. 2019;34(8);1837-1843.e2. PMID 31060915
  17. Loke RWK, Lim YH, Chan YK, et al. MAKO robotic-assisted compared to conventional total hip arthroplasty for hip osteoarthritis: a systematic review and meta-analysis. J Orthop Surg Res. 2025;20(1);466. PMID 40380310
  18. Huerfano E, Bautista M, Huerfano M, et al. Total hip arthroplasty in adolescents: a systematic review and meta-analysis. Int Orthop. 2024;48(9);2483-2492. PMID 38619564
  19. DeFrance MJ, Scuderi GR. Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature. J Arthroplasty. 2023;38(3);594-599. PMID 36252743
  20. Vajapey SP, McKeon JF, Krueger CA, et al. Outcomes of total joint arthroplasty in patients with depression: A systematic review. J Clin Orthop Trauma. 2021;18;187-198. PMID 34026486
  21. Riantho A, Butarbutar JCP, Fidiasrianto K, et al. Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. JB JS Open Access. 2023;8(2);e23.00010. PMID 37197698
  22. Salman LA, Hantouly AT, Khatkar H, et al. The outcomes of total hip replacement in osteonecrosis versus osteoarthritis: a systematic review and meta-analysis. Int Orthop. 2023;47(12);3043-3052. PMID 36905418
  23. de Ree RHGM, de Jong LD, Hazebroek EJ, et al. Optimal timing of hip and knee arthroplasty after bariatric surgery: A systematic review. J Clin Orthop Trauma. 2024;52;102423. PMID 38766387
  24. Dillon MT, Page RS, Graves SE, et al. Early revision in anatomic total shoulder arthroplasty in osteoarthritis: a cross-registry comparison. Shoulder Elbow. 2020;12(1 Suppl);81-87. PMID 33343719
  25. Roerink AMC, Nelissen RGHH, Holder C, et al. Sex-based differences in risk of revision for infection after hip, knee, shoulder, and ankle arthroplasty in osteoarthritis patients: a multinational registry study of 4,800,000 implants. Acta Orthop. 2024;95;730-736. PMID 39656214
  26. Davies AR, Sabharwal S, Liddle AD, et al. The risk of revision is higher following shoulder hemiarthroplasty compared with total shoulder arthroplasty for osteoarthritis: a matched cohort study of 11,556 patients from the National Joint Registry, UK. Acta Orthop. 2024;95;73-85. PMID 38289339
  27. Moran MM, Wessman P, Rolfson O, et al. The risk of revision following total hip arthroplasty in patients with inflammatory bowel disease, a registry based study. PLoS One. 2021;16(11);e0257310. PMID 34735461
  28. Gademan MGJ, Van Steenbergen LN, Cannegieter SC, et al. Population-based 10-year cumulative revision risks after hip and knee arthroplasty for osteoarthritis to inform patients in clinical practice: a competing risk analysis from the Dutch Arthroplasty Register. Acta Orthop. 2021;92(3);280-284. PMID 33478320
  29. Fowler TJ, Aquilina AL, Reed MR, et al. The association between surgeon grade and risk of revision following total hip arthroplasty : an analysis of National Joint Registry data. Bone Joint J. 2022;104-B(3);341-351. PMID 35227094
  30. Gill DRJ, Page BMedSci RS, Graves SE, et al. A Comparison of Revision Rates for Osteoarthritis of Primary Reverse Total Shoulder Arthroplasty to Primary Anatomic Shoulder Arthroplasty with a Cemented All-polyethylene Glenoid: Analysis from the Australian Orthopaedic Association National Joint Replacement Registry. Clin Orthop Relat Res. 2021;479(10);2216-2224. PMID 34180871
  31. Skou ST, Roos EM, Laursen MB, et al. A randomized, controlled trial of total knee replacement. N Engl J Med. 2015;373:1597-606. PMID 26488691
  32. Frydendal T, Christensen R, Mechlenburg I, et al. Total hip replacement or resistance training for severe hip osteoarthritis. N Engl J Med. 2024;391:1610-1620. PMID 39476341
  33. Beard DJ, Davies LJ, Cook JA, et al. Total versus partial knee replacement: the TOPKAT RCT. Health Technol Assess. 2020;24:1-98. PMID 32369436
  34. Wilson HA, Middleton R, Abram SGF, et al. Unicompartmental versus total knee replacement. BMJ. 2019;364:l352. PMID 30792179
  35. Price AJ, Alvand A, Troelsen A, et al. Knee replacement. Lancet. 2018;392:1672-1682. PMID 30496082
  36. Jayakumar P, Moore MG, Furlough KA, et al. Comparison of an AI-enabled patient decision aid vs educational material in knee osteoarthritis. JAMA Netw Open. 2021;4:e2037107. PMID 33599773
  37. Wluka AE, Yan MK, Lim KY, et al. Does preoperative neuropathic-like pain and central sensitisation affect the post-operative outcome of knee joint replacement? Osteoarthritis Cartilage. 2020;28:1403-1411. PMID 32791103