Multidimensional Assessment of Recovery After Total Knee Arthroplasty in Clinical Practice: Critical Narrative Review

Total knee arthroplasty (TKA) is the primary treatment for advanced knee osteoarthritis. Despite its clinical success and favorable patient-reported outcome measures (PROMs), approximately 20% to 30% of patients continue to experience persistent functional limitations and muscle weakness. This highlights the need for a comprehensive evaluation of recovery parameters beyond pain and range of motion. Given the wide range of methods available for assessing TKA outcomes, clinicians often select tools based on personal preference and understanding, which may affect accuracy and consistency; for example, the Knee Injury and Osteoarthritis Outcome Score may overestimate function compared to gait analysis studies.

The aim of this study was to conduct a narrative review focusing on the use, strengths, and limitations of different outcome measures used in routine orthopedic practice to optimize post-TKA evaluation.

A literature search was conducted in February 2025 across 2 databases (PubMed and Web of Science). Eligible studies included original research articles, systematic reviews, and meta-analyses that focused on validated measures used to evaluate TKA. Case reports, conference abstracts, and studies focused exclusively on surgical techniques were excluded. Themes were identified across studies to structure the results according to types of assessments and clinical applicability.

A total of 6831 studies were retrieved and screened in this review, with 4 themes emerging around muscle mass, strength, performance, and PROMs. The Oxford Knee Score is favored for its ease of use and minimal ceiling effects. Broader tools like the Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index provide detailed insights but are less practical clinically. For muscle strength, the portable fixed dynamometer showed high reliability and comparability to isokinetic dynamometry. Dual-energy X-ray absorptiometry remains the gold standard for assessing muscle mass, while bioelectrical impedance analysis offers a practical alternative. The 5-Repetition Sit-to-Stand test effectively evaluates lower limb power and speed.

Clinicians should integrate both objective (muscle mass, strength, and performance) and subjective (PROMs) measures to improve TKA recovery assessment. This multidimensional approach has the potential to enhance the accuracy of patient evaluation and supports the development of tailored rehabilitation strategies that address individual deficits and optimize functional outcomes.