Knee Surg Sports Traumatol Arthrosc. 2025 Nov 3. doi: 10.1002/ksa.70120. Online ahead of print.
ABSTRACT
PURPOSE: This systematic review and meta-analysis synthesises and critically appraises published literature on tibiofemoral articular noise following total knee arthroplasty (TKA) to determine the prevalence of noise among various implant designs.
METHODS: An electronic literature search was conducted using Embase, Medline and Epistemonikos. Inclusion criteria were studies reporting audible noise from the implant following TKA. Numbers and proportions of patients with articular noise were stratified according to TKA stabilisation mechanism: posterior-stabilised (PS), cruciate-retaining (CR), medial pivot (MP) or ultracongruent (UC). Pooled analysis was performed using a generalised linear mixed-effects model on studies that: (1) reported proportions with articular noise; (2) stratified by stabilisation mechanism; (3) reported the most recent or complete cohort and (4) excluded of clunk or crepitus.
RESULTS: Fourteen eligible studies, published between 1996 and 2024 (5769 knees), reported noise for 50 subsets (stabilisation mechanism, follow-up, or other differences). Follow-up ranged from 6 to 91 months, and the prevalence of audible noise ranged from 3% to 76%. Only 5 of the 14 studies could be included in the meta-analysis: 11 subsets were pooled into three stabilisation mechanisms and revealed the prevalence of articular noise to be highest for PS (35%), followed by UC (28%), and then CR (27%), but none were on MP. Sensitivity analysis revealed the prevalence of articular noise to be significantly higher for PS implants (31%) than for CR implants (24%, p = 0.012), but not significantly different to UC implants (23%, n.s.).
CONCLUSION: The prevalence of reported articular noise varied highly among studies, likely due to heterogeneity in patient demographics, follow-up period, implant design, type of noise and design of noise questionnaires. PS implants have considerably higher prevalence of noise compared to CR and UC implants. The clinical relevance of these findings is that surgeons and patients should be aware that 26%-35% of patients could experience articular noise following TKA, which is likely important to manage patient expectations.
CLINICAL TRIAL REGISTRATION: Systematic review protocol registration (Prospero: CRD42024607551).
LEVEL OF EVIDENCE: Level IV.
PMID:41182157 | DOI:10.1002/ksa.70120