Total knee arthroplasty improves sports activity and the patient-reported functional outcome at mid-term follow-up

Abstract

Purpose: The purpose of this study was to assess (1) sports participation and preference for the type of sports activity after TKA, (2) mid-term functional outcome and activity level, (3) correlation of different age groups with activity level and functional outcomes, and (4) mid-term survivorship of the prosthesis.

Methods: A retrospective review of prospectively collected data was performed. 182 patients were included who underwent primary TKA between January 2010 and December 2016. Inclusion criteria were symptomatic knee osteoarthritis, age 50-90 years, and with a minimum of 5-year follow-up after TKA. Patients with rheumatoid arthritis and revision TKA were excluded. Sports participation and sports preference, Oxford Knee Score (OKS), Tegner Activity Level, and Visual Analogue Scale (VAS) for pain were recorded pre- and postoperatively at 6 months, 1 year, 2 years, and 5 years. The patient cohort was subdivided according to age groups; activity levels, patient-reported outcomes, and improvement in knee pain were correlated with these age groups. Kaplan-Meier curves were used to investigate survivorship at a minimum of 5 years.

Results: The mean age of the cohort was 75.6 ± 7.2 years (range 52-89). Significant improvement was noted in sports participation (p < 0.003). After TKA, there was no change in the preference for sports and none of the patients had to discontinue their sporting activity. OKS improved significantly at all follow-up time points compared to the preoperative score (p < .0001). Patients' sports and physical activity improved significantly at 1 year compared to the preoperative activity level (p < 0.001). Although the Tegner activity level improved over time, this improvement was not significant (NS), while it was significantly higher in males than in females (p < 0.004). Significant improvement was found in the VAS for pain at all follow-up time points compared to the preoperative score (p < .0001). Survivorship was found to be 100% at a 5-year follow-up.

Conclusion: After TKA, patients can be able to return to sporting activity or even perform better than before surgery. Maximum improvement was noted in the first post-operative year. The male and younger groups perform better than the female and older groups. Sports and physical activity do not negatively impact survivorship of the knee prosthesis at mid-term follow-up and all patients are encouraged to take up sports participation after their TKA.

Level of evidence: Level 3.

Keywords: Functional outcome; Sports activity; Survivorship; TKA; Total knee arthroplasty; Total knee replacement; TKR.

Fig. 1

Whisker plots at preoperatively and postoperatively 6 months, 1-year, 2-year, 5-year follow-up for A OKS, B Tegner activity level, and C VAS for pain scores. Asterisks mark shows the statistically significant comparisons. Post-operative OKS, Tegner, and VAS for pain improved significantly compared to the preoperative score

Fig. 2

Comparison of the A OKS, B Tegner activity level, and C VAS for pain scores between 5 age subgroups at preoperatively and postoperatively 6 months, 1-year, 2-year, and 5-year follow-up. Post-operative OKS, Tegner, and VAS for pain improved significantly compared to the preoperative score

Fig. 3

Comparison of the A OKS, B Tegner activity level, and C VAS for pain scores between male and female patients at preoperatively and postoperatively 6 months, 1-year, 2-year, and 5-year follow-up. Post-operative OKS and VAS for pain between male and female patients were non-significant. Tegner activity level is significantly higher in males