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Open research questions in Total Knee Arthroplasty Outcomes

1,023 gap statements mined from Total Knee Arthroplasty Outcomes papers in our 7.9M-paper local library, which holds 4,851 papers on the topic — drawn mostly from each paper's own stated research gap, future-work, challenge and limitation notes, and its abstract. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one.

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What the literature leaves open

  • Current evidence is insufficient to favour cementless or cemented fixation for implant survival, MUA risk or hospital stay after robotic-assisted TKA. The available comparisons are observational, events are sparse and certainty is very low.

    Cementless versus cemented fixation in robotic-assisted total knee arthroplasty: a systematic review and meta-analysis · 2026 · DOI

  • Despite a substantially expanded evidence base compared with previous reviews, the overall body of evidence remains limited by small study sizes, heterogeneity in intervention design and comparators, and lack of AE reporting in post-TKA.

    Extended Reality Interventions for Osteoarthritis of the Knee and Recovery After Total Knee Arthroplasty: Systematic Review and Meta-Analyses · 2026 · DOI

  • The further development and efficacy assessment of DMOADs require a reliable tool to evaluate the degree of cartilage degradation. Whether semiquantitative US grade distributions differ among knee groups with different clinical statuses in relation to total knee arthroplasty for knee osteoarthritis remains unclear.

    Semiquantitative ultrasonographic grading of femoral cartilage: comparison among three knee groups with different clinical statuses · 2026 · DOI

  • Yet despite improvements, it remains to be shown whether cementless TKA (including more recent generations) can outperform cemented TKA in a large registry-based cohort study.

    Thirty-year outcomes of cemented versus cementless posterior-stabilized total knee arthroplasty · 2026 · DOI

  • Given the encouraging signal seen in reduced opioid requirements, further multicenter trials are warranted to validate these findings and define memantine’s role in enhanced recovery after TKA.

    Memantine as a pain management strategy post-total knee arthroplasty: a randomized controlled trial · 2026 · DOI

  • By contrast, there are very few prior studies that address OA in the flexion position as evaluated by the Rosenberg view, and no studies have compared extension OA with flexion OA as in our research.

    Clinical outcomes after medial open-wedge high tibial osteotomy are not affected by joint space in extension and flexion on standing radiographs · 2026 · DOI

  • These reviews concluded that kinematic alignment was comparable or slightly superior to MA, but differences are insufficient to explain the high percentage of dissatisfied TKA patients as the authors found no notable differences in femorotibial instability following surgical intervention.

    Biomechanical analysis of surgical alignment and design in total knee arthroplasty · 2026 · DOI

  • This helps identify potential areas with existing evidence gaps and identifies areas where future research is needed, so as to improve our management of this increasing cohort of patients with higher risk-factors. Although consensus was reached on 9 questions, there was lack of consensus for most of the questions, specifically where an objective cut off agreement was needed.

    Recommendations of an international Delphi study group for total knee arthroplasty in obese patients · 2026 · DOI

  • Limitations of this study can be categorized into methodological, data-related, and outcome-related factors. Data-related limitations involve missing the ASA physical status for a substantial proportion of R-UKA patients due to inconsistent documentation during early EHR implementation, representing a major limitation that restricts comorbidity-based risk adjustment and comparative interpretation.

    Long-term outcomes and revision-free survival following robotic-assisted unicompartmental and total knee arthroplasty · 2026 · DOI

  • Although our findings suggest that preoperative CPAK category was not associated with short-term outcomes after UKA, the prognostic significance of the postoperative CPAK change (or preservation) remains unclear.

    Does the preoperative CPAK classification influence clinical outcomes after medial and lateral unicompartmental knee arthroplasty? Short-term outcomes and phenotype distribution in a retrospective series of consecutive cases · 2026 · DOI

  • Finally, the results of this study are limited to the specific robotic system studied herein as planning and execution varies between robotic platforms.

    Short-term clinical outcomes of robotic-assisted total knee arthroplasty at 12-month follow-up: a prospective, multicenter, concomitant comparison to conventional total knee arthroplasty · 2026 · DOI

  • Future research should investigate whether the outcomes following revision surgery are worse in cases with a poor indication for primary TKA, as the underlying pain mechanism may not be biomechanical and therefore not resolvable by the revision procedure.

    Preoperative lower radiographic osteoarthritis severity in primary total knee arthroplasty increases revision risk by tenfold compared to severe osteoarthritis · 2026 · DOI

  • Finally, although KA-TKA aims to restore each patient’s native morphology, it remains uncertain to what extent the reconstructed joint surface replicates the true prearthritic anatomy.

    Patient Perception of Lower-Limb Straightness at One Week After Unrestricted Kinematically Aligned Total Knee Arthroplasty: Exploring the Concept of “Inherent Straightness” · 2026 · DOI

  • Furthermore, sequential or combined therapy regimens should be explored: the use of bisphosphonates after discontinuation of denosumab is recommended to prevent rebound, but there are no studies evaluating whether this strategy influences implant stability.

    Perioperative denosumab exposure and risk of revision after total hip and knee arthroplasty in osteoarthritis: a registry-based data linkage study · 2026 · DOI

  • Data availability No data were used in this letter. Without accounting for these two established predictors—radiographic severity and preoperative pain intensity—it remains uncertain whether the observed improvement in pain outcomes was truly related to MDT implementation or instead reflected baseline differences between the pre-MDT and post-MDT cohorts.

    Comment on “Impact of a multidisciplinary pain management team on acute and chronic pain management after total knee arthroplasty” · 2026 · DOI

  • Further research is needed to determine whether alternative alignment philosophies provide additional clinical benefit while maintaining adequate implant fixation and survivorship. Although patient-specific alignment philosophies have gained increasing interest in recent years, their potential benefits in BCR TKA remain uncertain, a0.

    Stable 2-year migration on radiostereometric analysis and improved gait speed and function after bicruciate-retaining TKA: a prospective cohort of 25 patients · 2026 · DOI

  • The benefits of computer navigation in TKA are well established over a longer time frame, and although early studies have demonstrated some benefits of robotic systems, there is limited evidence on the clinical outcomes and patient reported outcomes (PROMs) compared to computer navigation.

    Is it really worth changing from computer navigation to robotic knee replacement? A Prospective Study to Compare Patient Outcomes Following Robotic-Assisted and Computer Navigated TKA · 2026 · DOI

  • Unlike coronal malalignment, little is known about whether sagittal and rotational malalignment increases failure rates in mechanically aligned (MA) total knee arthroplasty (TKA).

    Unintentional Valgus Malalignment in Mechanically Aligned Total Knee Arthroplasty Leads to Higher Prosthetic Failure Rates. A National Registry Survivorship Analysis of Coronal, Sagittal and Rotational Alignment Using Computed Tomography · 2026 · DOI

  • The first major limitation of this study is that although the mathematical formula is fully valid for calculating the correct position of the PTA relative to the QLF, the clinical results supporting the hypothesis of this study are limited, with data coming from a small patient sample.

    The Orientation of the Prosthetic Trochlear Angle Is Predictable in Kinematically Aligned Total Knee Arthroplasty · 2025 · DOI

  • Our findings expand this knowledge by demonstrating that improvements in chronic posterior knee pain were observed following the IPACK block in osteoarthritis, not only limited to acute postoperative pain. Importantly, the present study addresses a clinically underrecognized pain phenotype in knee osteoarthritis-predominant posterior knee pain.

    Clinical Outcomes of Ultrasound-Guided IPACK Block for Posterior Knee Pain in Advanced Osteoarthritis: A Multicenter Prospective Single-Arm Study · 2026 · DOI

  • Similar fndings are reported using the Tonnis classifcation,15 but evidence is mixed, with some studies showing no association with postoperative PROMs.

    Radiological pattern of hip osteoarthritis is associated with one-year patient-reported outcomes but not long-term mortality or revision after total hip arthroplasty · 2026 · DOI

  • For example, it is not currently possible to record more than one operating surgeon per case in the NJR, which does not account for procedures that have been part-performed by a trainee. This could reflect differing decision-making thresholds among supervising teams, though this could not be assessed within the available data.

    Association between surgeon training grade and the risk of revision following total knee replacement: An analysis of National Joint Registry data · 2025 · DOI

  • In the included trials, nurse-led programs operated alongside, not instead of, surgical follow-up and routine physiotherapy, and the most plausible model of benefit is complementary: Physiotherapists prescribe and progress exercise, while nurses provide the education, monitoring, and self-efficacy support that sustain adherence between formal contacts, within teams that may also include rehabilitation physicians…

    Nurse-led rehabilitation after total hip or knee arthroplasty: a systematic review and meta-analysis of functional recovery, self-efficacy, and quality of life · 2026 · DOI

  • No access to and therefore did not control for all factors known to affect recovery, - No anthropometric normalization was performed, - No calibration is required for the inertial motion data, - Limited to patients with available data, - No temporal interpolation or imputation…

    Real-World Functional Gait Recovery Trajectories After Total Hip and Total Knee Arthroplasty via Smartphone Sensors: Observational Longitudinal Study (Preprint) · 2026 · DOI

  • Investigate the effect of surgical approach, implant type, perioperative protocols, rehabilitation protocols, pain level, or comorbidities on recovery, - Examine the relationship between gait parameters and patient outcomes, - Develop methods for anthropometric…

    Real-World Functional Gait Recovery Trajectories After Total Hip and Total Knee Arthroplasty via Smartphone Sensors: Observational Longitudinal Study (Preprint) · 2026 · DOI

Most-cited papers in Total Knee Arthroplasty Outcomes

Most recent work

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Open questions raised by papers listed on this page include: (1) Despite a substantially expanded evidence base compared with previous reviews, the overall body of evidence remains limited by small study sizes, heterogeneity in intervention design and comparators, and lack of AE reporting in post-TKA (“Extended Reality Interventions for Osteoarthritis of the Knee and Recovery…”, 2026); (2) Yet despite improvements, it remains to be shown whether cementless TKA (including more recent generations) can outperform cemented TKA in a large registry-based cohort study (“Thirty-year outcomes of cemented versus cementless posterior-stabilized total…”, 2026); (3) Given the encouraging signal seen in reduced opioid requirements, further multicenter trials are warranted to validate these findings and define memantine’s role in enhanced recovery after TKA (“Memantine as a pain management strategy post-total knee arthroplasty: a…”, 2026); (4) Although consensus was reached on 9 questions, there was lack of consensus for most of the questions, specifically where an objective cut off agreement was needed (“Recommendations of an international Delphi study group for total knee…”, 2026); (5) Further research is needed to determine whether alternative alignment philosophies provide additional clinical benefit while maintaining adequate implant fixation and survivorship (“Stable 2-year migration on radiostereometric analysis and improved gait speed…”, 2026). 1,023 gap statements have been mined from Total Knee Arthroplasty Outcomes papers in our 7.9M-paper local library, which holds 4,851 papers on the topic; the gaps come from whichever of those papers state one. They are mostly the research gaps the authors state and the papers' abstracts, plus future-work, limitations and challenges passages. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one, so you can read the original claim in context.

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