Sporting a Life After Total Knee Replacement

Patients that undergo total knee arthroplasty (TKA) may be able to participate in high-impact sports without increasing the risk that their implant will prematurely fail, a new study has concluded.

The study, which was presented at the 77th Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in New Orleans, La., found that patients who participated in activities discouraged by the Knee Society (KS) had better clinical scores than those wo abided by the KS recommendations.

The Knee Society – based in Rosemont, Ill. – recommends that TKA patients avoid activities that can cause high stress loads on the implant and increase the risk of early failure. Such activities include high-impact aerobics, football, soccer, baseball, basketball, jogging and power-lifting.

“Recent studies have shown that as many as one in six total knee replacement patients participate in non-recommended activities,” said Sebastian Parratte, M.D., PhD, an orthopaedic surgeon from the Mayo Clinic in Rochester, Minn., and the Aix-Marseille University, Center for Arthritis Surgery, Hospital Sainte-Marguerite in Marseille, France. “This study offers some reassurance to those patients who choose to return to an active lifestyle after surgery.”

The study’s authors based their conclusions on research that was conducted at the Mayo Clinic on 535 patients between the ages of 18 and 90. The patients were divided into two groups: those who performed heavy manual labor or participated in a non- (KS) recommended sport after undergoing TKA (218 people), and those who followed KS recommended post-surgery guidelines (317 people).

At an average follow-up of seven-and-a-half years after surgery, the study found no significant radiological differences and no significant differences in implant durability between the two groups. In addition, the group that participated in high-impact sports showed slightly higher KSknee and function scores than those who followed the society’s guidelines.

The study also found that patients who abided by KS recommendations experienced a 20 percent higher revision rate for mechanical failure (loosening, wear or fracture) compared to those that participated in high-impact sports. And, after accounting for all variables – including co-morbidities – the study found that the implants of those who participated in high-impact sports had a 10 percent higher risk of mechanical failure.

Paratte and his team were surprised by the results.

“We hypothesized that high-impact activities would not increase the risk of implant failure, but we did not foresee that such activities might actually improve clinical results,” he said. “It is clear that more research is necessary to evaluate the short and long-term effect of high-impact activities on the durability and function of modern TKA implants.”

Despite the results, the industry is not prepared to revise its recommendations at this time. Paratte suggested that surgeons and patients continue following all industry recommendations relating to recovery following joint replacement surgery.