Improvement of sleep quality 6 months after total knee arthroplasty: a systematic review and meta-analysis

Background Total knee arthroplasty (TKA) is an accepted, effective treatment to restore function, relieve pain, and improve the quality of life in patients with advanced osteoarthritis. One complication of this major surgery is impaired sleep quality. This study examines the quality of sleep in patients undergoing TKA before and after their operation. Methods All relevant records were obtained using a systematic search in three online databases: PubMed, Scopus, and Cochrane library. Out of the 177 records retrieved, only eight matched the inclusion criteria. Due to the lack of sufficient data, only four studies entered the meta-analysis. Values reported for sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) were extracted from patient records before and after surgery. A random-effect model was used to analyze the data. Results The results of the meta-analysis show a significant difference in the improvement of sleep quality after surgery at two time points of 4-6 weeks after surgery from the preoperative baseline (SMD - 0.16; 95% CI - 1.05 to 0.74; P = 0.0) and 3-6 months after surgery from the preoperative baseline (SMD - 0.92; 95% CI - 1.61 to - 0.24; P = 0.0). Conclusions The results show that TKA generally improves the patients' sleep quality. Although some studies reported disrupted sleep quality in periods close to the surgery (especially in the early days after surgery), all studies have reported improved sleep quality in the late postoperative intervals.