1. Conferences Overview
    2. Deutscher Kongress für Orthopädie und Unfallchirurgie 2026 (DKOU 2026)
    3. Impact of creatine on osteoarthritis and prehabilitation in total knee arthroplasty – a PRISMA systematic review
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Deutscher Kongress für Orthopädie und Unfallchirurgie 2026 (DKOU 2026)

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC), Deutsche Gesellschaft für Unfallchirurgie (DGU), Berufsverband für Orthopädie und Unfallchirurgie (BVOU)
20.-23.10.2026
Berlin

Meeting Abstract

Impact of creatine on osteoarthritis and prehabilitation in total knee arthroplasty – a PRISMA systematic review

Hussain Zaidi - Imperial College London, Department of Bioengineering, St. George’s University of London, London, UK
William Jackson - Oxford University Hospitals NHS, Nuffield Orthopaedic Centre, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford, UK
Abtin Alvand - Oxford University Hospitals NHS, Nuffield Orthopaedic Centre, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford, UK
Andrew Price - Oxford University Hospitals NHS, Nuffield Orthopaedic Centre, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford, UK
Andrew Wickline - Department of Orthopedic Surgery, Genesee Orthopedics, New Hartford, New York, USA
Reza Jazayeri - Department of Sports Medicine, Permanente Medical Group Los Angeles, Los Angeles, CA, USA
Eleftherios Tsiridis - Aristotle University of Thessaloniki, Academic Orthopaedic Department, Campus PGH, Thessaloniki, Griechenland
Georgi Wassilew - Universitätsmedizin Greifswald, Klinik für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Greifswald, Deutschland
Alexander Maslaris - Universitätsmedizin Greifswald, Klinik für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Aristotle University of Thessaloniki, Academic Orthopaedic Department, Campus PGH, Thessaloniki, Griechenland

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Objectives and questions: Creatine is a widely used ergogenic supplement known to enhance short-duration, high-intensity performance, yet its role in the management of knee osteoarthritis (OA) and in support of the patient pathway around knee arthroplasty (TKA) remains uncertain. This systematic review aims to evaluate the effects, benefits, risks and optimal dosing of Creatine Monohydrate supplementation and integration of supplementation into TKA prehabilitation pathways to support Enhanced Recovery After Surgery (ERAS).

Material and methods: A systematic review was conducted in full accordance with the PRISMA 2020 guidelines. Major databases were searched through September 2025 for RCTs and prospective studies. Primary outcomes were functional performance, strength, patient-reported outcome measures (PROMS); secondary outcomes included renal safety. Given limited OA-specific trials, broader RCTs involving combining creatine supplementation with resistance training were included for context.

Results: Four OA-specific RCTs met inclusion criteria. Creatine combined with resistance training improved function and lean mass versus placebo, while creatine alone did not significantly affect KOOS scores, strength or biomarkers. A renal sub study confirmed no impairment of glomerular filtration rate. Nine non-TKA specific RCTs investigating the effects of creatine supplementation with resistance training consistently demonstrated gains in strength and lean mass when creatine was paired with resistance training. No recent trials have evaluated outcomes post-TKA, though several are registered. Notably, this represents a missed opportunity within ERAS-driven peri-operative care, where modifiable prehabilitation strategies with proven safety and physiological benefit remain underutilised.

Discussion and conclusions: Creatine is not disease-modifying for OA but is a safe, low-cost adjunct that enhances muscular rehabilitation when combined with resistance training. Incorporating creatine supplementation into TKA protocols may have some value and future creatine specific TKA studies are justified.