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Related Experiment Video

Updated: Jan 30, 2026

Reverse Total Shoulder Arthroplasty
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Selecting and optimising patients for total knee arthroplasty.

Sam Adie1,2, Ian Harris3, Alwin Chuan3,4

  • 1St George and Sutherland Clinical School, UNSW, Sydney, NSW.

The Medical Journal of Australia
|January 19, 2019
PubMed
Summary

Total knee arthroplasty (TKA) requires significant symptoms, but specific thresholds for surgery are unclear. Pre-operative optimization, like smoking cessation, may improve outcomes, while age and sex are not contraindications.

Keywords:
ArthritisArthroplasty, replacementKnee injuries

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering

Background:

  • Total knee arthroplasty (TKA) is indicated for significant, prolonged symptoms with clinical and radiological evidence.
  • Limited evidence exists for specific symptom thresholds to justify TKA surgery.

Purpose of the Study:

  • To review the minimum requirements for TKA and factors influencing outcomes.
  • To assess the evidence for pre-operative optimization strategies.

Main Methods:

  • Literature review of studies on TKA indications, patient factors, and pre-operative optimization.
  • Analysis of evidence from randomized controlled trials and guidelines.

Main Results:

  • Non-operative treatments may improve symptoms and delay surgery but won't reverse radiographic changes.
  • Patient factors like mental health and obesity affect outcomes but are not contraindications.
  • Pre-operative rehabilitation shows minimal effect; smoking cessation may improve outcomes.
  • Cardiorespiratory optimization guidelines should be followed.

Conclusions:

  • TKA indications focus on symptom severity and radiological signs, not strict age or sex cut-offs.
  • Pre-operative optimization evidence is limited, but smoking cessation and cardiorespiratory management are recommended.
  • Further research is needed on optimizing patient expectations, diabetes, obesity, and vascular disease pre-TKA.