• total knee replacement
• total knee arthroplasty
• return to sport

• Humans
• Arthroplasty, Replacement, Knee/rehabilitation
• Male
• Female
• Return to Sport/statistics & numerical data
• Retrospective Studies
• Aged
• Australia
• Middle Aged
• Surveys and Questionnaires
• Aged, 80 and over
• Patient Satisfaction

• University of Sydney

• Arthroplasty
• Knee
• Replacement
• Return to daily activities
• Return to sports
• Return to work

• arthroplasty
• osteoarthritis
• patellofemoral
• knee
• patellofemoral joint arthroplasty
• total knee arthroplasty (tka)
• pfj
• randomized controlled trials
• patient-reported outcome measures (proms)
• patellofemoral joint
• surgical treatments
• cohort studies

• Humans
• Arthroplasty, Replacement, Knee
• Sports
• Knee Joint/surgery
• Knee Prosthesis
• Polyethylene

• UKR
• activity
• fixed bearing
• lateral unicompartmental knee arthroplasty
• partial knee replacement

• Functional outcome
• Sports activity
• Survivorship
• TKA
• Total knee arthroplasty
• Total knee replacement 
•  TKR

• Meta-analysis
• Physical activity
• Return to sports
• Total knee arthroplasty

A growing number of physically active patients undergoing total knee replacement (TKR) desires to resume their preoperative activity levels and to be able to engage in sports after surgery. The purpose of this study was to assess the sporting and physical activities of patients who had undergone TKR. It was hypothesized that the majority of patients treated by TKR would have been able to return to amateur sports and recreational activity .

Ninety-seven patients who underwent TKR between 2014 and 2016, were retrospectively reviewed. Mean age was 70.1 years (range 64–83). Average follow-up time was 4.2 years (SD: 1.7). Assessment included Knee Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and Tegner activity level. Sporting and physical activities of all patients were reported. Wilcoxon’s signed ranks test was used for comparison between pre-operative and follow-up data. Significance was set at p < 0.05.

Both KOOS score and IKDC significantly improved after surgery (p < 0.001). No statistically significant differences were reported concerning Tegner activity level before and after surgery (p = n.s.). After surgery, a total number of 52 patients (53.6%) successfully returned to sporting and recreational activities, such as cycling, hiking, dancing and swimming. A return to activity rate of 81% of patients practicing sport before surgery was reported.

TKR provides a high rate of return to sport postoperatively and confirms improved subjective results and reduced pain compared to preoperative status. However, most patients returned to low-impact activities, while a significant decrease was reported for mid- and high-impact sports.

• Total knee replacement
• activity level
• knee prostheses
• outcomes
• return to sports

• Axial alignment
• Cartilage
• High tibial valgus osteotomy
• Knee
• Osteoarthritis
• Posterior tibial slope
• Triangle method
• Weight bearing line

• golf
• hip replacement
• joint replacement in athletes
• knee replacement
• shoulder replacement

• meta-analysis
• physical activity
• review
• sport
• total knee arthroplasty

Desires and expectations of patients in regard to resume participation in sport activities after knee arthroplasty strongly increased in recent years. Therefore, this review systematically reviewed the available scientific literature on the effect of knee arthroplasty on sports participation and activity levels.

Systematic review and meta-analysis.

PubMed, Embase, SPORTDiscus and reference lists were searched in February 2019.

Inclusion of knee osteoarthritis patients who underwent total knee arthroplasty (TKA) and/or unicondylar knee arthroplasty. Studies had to include at least one preoperative and one postoperative measure (≥1 year post surgery) of an outcome variable of interest (ie, activity level: University of California, Los Angeles and/or Lower Extremity Activity Scale; sport participation: type of sport activity survey).

Nineteen studies were included, consisting data from 4074 patients. Knee arthroplasty has in general a positive effect on activity level and sport participation. Most patients who have stopped participating in sport activities in the year prior to surgery, however, do not seem to reinitiate their sport activities after surgery, in particular after a TKA. In contrast, patients who continue to participate in sport activities until surgery appear to become even more active in low-impact and medium-impact sports than before the onset of restricting symptoms.

Knee arthroplasty is an effective treatment in resuming sports participation and physical activity levels. However, to achieve the full benefits from knee arthroplasty, strategies and guidelines aimed to keep patients capable and motivated to participate in (low-impact or medium-impact) sport activities until close before surgery are warranted.

• knee surgery
• osteoarthritis
• physical activity
• sport

• activity
• elderly
• knee osteoarthritis
• sport
• unicompartimental knee arthroplasty

Introduction: The number of total knee replacements performed (TKR) is increasing and so are patient expectations and functional demands. The mean age at which orthopedic surgeons may indicate TKR is decreasing, and therefore return to sport (RTS) after TKR is often an important expectation for patients. The aim of this study was to analyze the mid-term RTS, recreational activities, satisfaction level, and forgotten joint level after TKR. Methods: Between January 2015 and December 2016, 536 TKR (same implant design, same technique) were performed in our center. The mean age at survey was 69 years with a mean follow-up of 43 months. All patients who did not have a follow-up in the last 6 months were called. Finally, 443 TKR were analyzed. RTS was assessed using the University of California Los Angeles Scale (UCLA), forgotten joint score (FJS), and Satisfaction Score. Results: In this study, 85% of patients had RTS after TKR with a mean UCLA score increasing from 4.48 to 5.92 and a high satisfaction rate. Satisfaction with activity level was 93% (satisfied and very satisfied patients). The RTS is more important for people with a higher preoperative UCLA score and a lower American Society of Anesthesiologist score (ASA). Each point increase in ASA score is associated with reduced probability to RTS by 52%. Discussion: RTS and recreational activity were likely after TKR with a high satisfaction score. Preoperative condition and activity are the two most significant predictive factors for RTS. Level of evidence: Retrospective case series, level IV.

• Patient satisfaction
• Recreational activities
• Return to sport
• Total knee replacement

• activity
• arthroplasty
• golf
• handicap
• knee
• sport

• Mesenchymal stem cell
• Osteroarthritis
• Second-look arthroscopy
• Umbilical cord blood

• Active lifestyle
• Arthroplasty
• Health
• Knee replacement
• Physical activity
• Return to sport

• 6-Minute walk test
• Highly active
• Self-reported physical activity
• Total hip arthroplasty
• WOMAC

• Gap balancing
• Knee
• MC
• Medial pivot
• Polyethylene
• Results
• TKA
• Total knee arthroplasty

• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Knee/methods
• Female
• Humans
• Knee Joint/diagnostic imaging
• Knee Joint/physiopathology
• Knee Joint/surgery
• Knee Prosthesis
• Male
• Middle Aged
• Osteoarthritis, Knee/diagnosis
• Osteoarthritis, Knee/physiopathology
• Osteoarthritis, Knee/surgery
• Patient Satisfaction
• Polyethylene
• Prosthesis Design
• Range of Motion, Articular/physiology
• Treatment Outcome

• Arthroplasty, replacement, hip
• Long-term care
• Sports
• Sports medicine

Total hip and knee replacements are being performed in increasing numbers in progressively younger patients with higher activity demands. Many such patients have expectations of returning to athletic activity post-operatively yet are not always able to do so and the reasons behind this have not been extensively examined. We hypothesise that any reasons for a failure to return to athletic activity post-operatively are multi-factorial.

To quantify the return to athletic activity following lower limb joint arthroplasty and understand qualitative reasons for altered activity participation.

A single centre, single surgeon retrospective questionnaire for hip and knee arthroplasty patients under age 60 years, minimum two years post-surgery with exclusion criteria of multiple degenerative joint involvement and multiple medical co-morbidities. Outcomes were validated joint-specific (Oxford hip and knee) and lifestyle questionnaires [short form 12 (SF-12) and University of California, Los Angeles (UCLA)] and an activity questionnaire assessing ability participation in athletic activity post-operatively. Statistical analysis was performed on the validated outcome data, including comparison between hip and knee replacements. Frequency tables were produced to quantify the different athletic activities participated in by patients.

Responses were received from 64 patients (80% response rate). There was a statistically significant improvement in Oxford hip and knee scores following surgery. SF-12 scores also improved for all patients, but no statistically significant difference was seen between joints (P = 0.88). Mean UCLA scores pre-operatively were 7.67 and at two years post-operatively were 7.69, with no statistically significant change (P = 0.91). All patients reported high satisfaction and improved ability to perform athletic activity at a higher frequency compared to pre-operatively. The most common reasons for changing activity participation were not wanting to stress their joint replacement or instructions by other doctors or the lead surgeon. There was no difference in the responses to the questionnaire based on type of joint replacement (P = 0.995).

Patients receiving a joint replacement are able to participate in athletic activity to high levels and are satisfied with their outcomes. Reasons for non-participation are multi-factorial.

• Joint replacement
• Athletic activity
• Sport
• Outcomes

• Arthroplasty, Replacement, Knee
• Human activities
• Patient satisfaction
• Rehabilitation

• Arthroplasty
• Hip
• Prostheses and implants
• Sports

Golf is commonly considered a low-impact sport that carries little risk of injury to the knee and is generally allowed following total knee arthroplasty (TKA). Kinematic and kinetic studies of the golf swing have reported results relevant to the knee, but consensus as to the loads experienced during a swing and how the biomechanics of an individual’s technique may expose the knee to risk of injury is lacking.

Our objective was to establish (1) the prevalence of knee injury resulting from participation in golf and (2) the risk factors for knee injury from a biomechanical perspective, based on an improved understanding of the internal loading conditions and kinematics that occur in the knee from the time of addressing the ball to the end of the follow-through.

A systematic literature search was conducted to determine the injury rate, kinematic patterns, loading, and muscle activity of the knee during golf.

A knee injury prevalence of 3–18% was established among both professional and amateur players, with no clear dependence on skill level or sex; however, older players appear at greater risk of injury. Studies reporting kinematics indicate that the lead knee is exposed to a complex series of motions involving rapid extension and large magnitudes of tibial internal rotation, conditions that may pose risks to the structures of a natural knee or TKA. To date, the loads experienced by the lead knee during a golf swing have been reported inconsistently in the literature. Compressive loads ranging from 100 to 440% bodyweight have been calculated and measured using methods including inverse dynamics analysis and instrumented knee implants. Additionally, the magnitude of loading appears to be independent of the club used.

This review is the first to highlight the lack of consensus regarding knee loading during the golf swing and the associated risks of injury. Results from the literature suggest the lead knee is subject to a higher magnitude of stress and more demanding motions than the trail knee. Therefore, recommendations regarding return to golf following knee injury or surgical intervention should carefully consider the laterality of the injury.

The online version of this article (doi:10.1007/s40279-017-0780-5) contains supplementary material, which is available to authorized users.

• Functional abilities
• Oxford Knee Score
• Sports activity
• Tegner Activity Level
• Total knee arthroplasty
• Visual Analog Scale

• Aged
• Arthroplasty, Replacement, Knee
• Female
• Humans
• Lysholm Knee Score
• Male
• Middle Aged
• Pain Measurement
• Prospective Studies
• Return to Sport
• Surveys and Questionnaires

• Activity
• Glenohumeral arthritis
• Hemi shoulder arthroplasty
• Return to work
• Sports participation

• Patient expectations
• Reverse shoulder arthroplasty
• Sports
• Survey

• knee arthroplasty
• patient information
• rehabilitation
• return to sport

• Long term outcomes in TKA
• Predictors of failure in TKA
• Young patients with TKAs

• Outcomes
• Severe deformity
• Unicondylar knee arthroplasty

• arthroplasty
• golf
• hip
• knee
• shoulder

Total knee arthroplasty (TKA) is routinely performed in younger patients who desire to be active in fitness and recreational sports. The activities patients can participate in without symptoms and the level of aerobic fitness routinely maintained are important to investigate.

To determine physical activity (PA) and recreational sports resumed after primary TKA, symptoms or limitations with these activities, and the effect of postoperative rehabilitation on achieving fitness and sports goals.

A systematic review of the literature from 2005 through 2015 was conducted using the PubMed database.

Original investigations that were conducted at least 1 year after primary TKA and reported the percentage of patients who returned to recreational activities or routinely participated in aerobic PA recommended by the American Heart Association (AHA) were included in this study.

Systematic review.

Level 4.

Data were extracted as available from 19 eligible studies. Assessment of study quality was rated using the MINORS (Methodological Index for Non-Randomized Studies) instrument.

There were 5179 knees (mean age, 67.5 years) followed for a mean 4.8 years postoperatively. Marked variability was present between studies regarding the percentage of patients who resumed recreational activities (34%-100%), most of which were low impact. Only 2 studies used accelerometers to measure PA; these reported a low range (0%-16.5%) of patients who met AHA guidelines. Few studies determined whether symptoms or limitations were experienced during PA. None described rehabilitation exercises or factors that would influence patients’ ability to return to recreational or fitness activities.

Little evidence is available regarding the effect of TKA on return to recreational and (objectively measured) aerobic fitness. The extent of symptoms or limitations during PA and the long-term effects of such problems remain unclear. Valid predictions cannot be made on factors that may affect return to recreational sports or other aerobic PA after TKA.

• physical fitness
• recreational activities
• total knee arthroplasty

• Arthroplasty, Replacement, Knee
• Exercise
• Humans
• Knee Joint/surgery
• Observational Studies as Topic
• Recovery of Function
• Return to Sport
• Sports

• NutsOhra Foundation

• activity
• knee arthroplasty
• medial UKR
• mobile bearing
• sport
• unicondylar knee arthroplasty

• Activity
• Knee arthroplasty
• Lateral UKA
• Mobile bearing
• Sport
• UKR

Total knee arthroplasty (TKA) is the most commonly performed elective surgery in the United States. TKA typically improves functional performance and reduces pain associated with knee osteoarthritis. Little is known about the influence of TKA on overall physical activity levels. Physical activity, defined as “any bodily movement produced by skeletal muscles that results in energy expenditure”, confers many health benefits but typically decreases with endstage osteoarthritis. The purpose of this review is to describe the potential benefits (metabolic, functional, and orthopedic) of physical activity to patients undergoing TKA, present results from recent studies aimed to determine the effect of TKA on physical activity, and discuss potential sources of variability and conflicting results for physical activity outcomes. Several studies utilizing self-reported outcomes indicate that patients perceive themselves to be more physically active after TKA than they were before surgery. Accelerometry-based outcomes indicate that physical activity for patients after TKA remains at or below pre-surgical levels. Several different factors likely contributed to these variable results, including the use of different instruments, duration of follow-up, and characteristics of the subjects studied. Comparison to norms, however, suggests that daily physical activity for patients following TKA may fall short of healthy age-matched controls. We propose that further study of the relationship between TKA and physical activity needs to be performed using accelerometry-based outcome measures at multiple post-surgical time points.

• Physical activity
• Knee osteoarthritis
• Self-report
• Total knee arthroplasty
• Accelerometer

It is important to identify the reasons or factors preventing patients from participating in sports activities after total knee arthroplasty (TKA) to improve patient satisfaction and general health that can be gained from regular sports activities.

To determine the reasons for lack of participation in regular sports activities after TKA as perceived by patients and to identify specific factors involved.

Case series; Level of evidence, 4.

A total of 369 patients with a follow-up longer than 1 year after TKA were included in this retrospective study. A postal survey regarding sports activities was conducted using a questionnaire gathering information such as sociodemographic data, activity levels, and sports activities after TKA. The reasons perceived by patients for not participating in sports activities were determined. Patients unable to participate in sports activities were compared with patients able to do so in terms of sociodemographic data and pre- and postoperative outcomes.

Of the 369 patients, 88 (24%) replied that they could not participate in a sports activity. Among the perceived reasons, reasons not related to the replaced knee were more frequent than those related to the replaced knee (76% vs 24%). Symptoms related to the spine or other joints composed 25% of the total perceived reasons. The presence of medical comorbidities accounted for 16%, while symptoms in the nonreplaced knee represented 8% of the reasons. In terms of patient factors, multivariate logistic regression revealed that male sex, a floor-based (ie, non-Western) lifestyle with greater demands on knee flexion, and worse postoperative University of California at Los Angeles activity scale were associated with nonregular sports activity levels.

The perceived reasons and patient factors hindering regular sports activities after TKA were not restricted to problems with the replaced knee. Nonetheless, orthopaedic surgeons may have a substantial role in encouraging patients to participate in sports by resolving joint-related problems. Furthermore, this study supports the notion that a multidisciplinary approach is needed to improve sports participation after surgery.

• outcome
• preventing factor
• sports activity
• total knee arthroplasty

• Adolescent
• Adult
• Bone Neoplasms/surgery
• Child
• Female
• Follow-Up Studies
• Humans
• Knee Joint/surgery
• Knee Prosthesis
• Limb Salvage
• Male
• Middle Aged
• Osteosarcoma/surgery
• Plastic Surgery Procedures
• Retrospective Studies
• Sports
• Survivors
• Young Adult

The objectives of this study were to describe changes in physical activity profiles of Korean patients after TKA and to determine whether the postoperative physical activity level is influenced by patient socio-demographic factors and postoperative functional outcomes. We also sought to determine whether regular postoperative physical activity is associated with greater patient satisfaction after TKA.

This observational study included 369 patients. Physical activity profiles before and after TKA were evaluated using a questionnaire that contained the UCLA activity scale and types of sports activities. The associations of socio-demographic features and postoperative functional outcomes with the physical activity levels were assessed using subgroup comparisons and partial correlation analyses. In addition, the effects of regular physical activity on patient satisfaction with replaced knees were evaluated using subgroup comparisons.

Walking, swimming and bicycling were the three most common sports activities both before and after TKA. After TKA, the mean activity level remained similar (UCLA score = 4.5 before TKA vs. 4.8 after TKA); however, the frequency of moderate activity levels (UCLA scale, 4-6) and moderate types of physical activities increased. Patients with higher postoperative function scores reported higher postoperative activity levels, but socio-demographic factors were not associated with activity level. Regular physical activity was associated with greater patient satisfaction.

This study provides valuable information about realistic expectations for physical activity after TKA. Regular participation in physical activity should be encouraged to improve patient satisfaction.