The role of electromyography in postoperative total knee arthroplasty: A systematic review.

Background: Electromyography (EMG) measures electrical activity in muscle fibers during contractions after total knee arthroplasty (TKA), with higher amplitudes indicating stronger or compensatory muscle engagement. Despite increased TKA procedures, 10 % of patients report stiffness and mobility issues. In recent years, EMG has been increasingly used in physical therapy as biofeedback to enhance muscle strength and control by translating muscle activity into visual signals for patients. Methods: This systematic review adhered to PRISMA guidelines, searching PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the Physiotherapy Evidence Database for peer-reviewed original research articles in English that used EMG for post-operative assessment in TKA patients, excluding studies on other type of knee surgeries. Data extracted included study design, number of patients, and the reasons and outcomes of EMG use. Results: Fifty-three studies from 1999 to 2023 were analyzed. Findings varied widely, influenced by follow-up length, patient age, and exercise protocols. Limited trends were observed, and more randomized controlled trials are needed. Three randomized controlled trials indicated that EMG biofeedback can reduce pain shortly after surgery, particularly in older patients, but its impact on long-term functional outcomes varies. The effectiveness of EMG biofeedback depends on the patient's age, recovery goals, and intervention timing. Conclusions: While EMG can enhance postoperative care by providing detailed insights into muscle recovery after TKA, its widespread application requires careful consideration. More research is needed to determine if biofeedback can effectively guide therapy.