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Does high activity after total and unicompartmental knee arthroplasty increase the risk for aseptic revision?

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

It has been suggested that high activity might negatively impact implant survival following total and unicompartmental knee arthroplasty (TKA/UKA) and many surgeons advise their patients to only participate in moderate level sport activities. To date, it remains unclear whether such restraints are necessary to assure longevity of the implants.

Materials and methods

We conducted a retrospective study on 1906 knees (1745 TKA, 161 UKA) in 1636 patients aged 45–75 years who underwent primary arthroplasty for primary osteoarthritis. Lower extremity activity scale (LEAS) at a two year follow-up was assessed to define the activity level. Cases were grouped in low (LEAS ≤ 6), moderate (LEAS 7–13) and high activity (LEAS ≥ 14). Cohorts were compared with Kruskal–Wallis- or Pearson-Chi2-Test. Univariate logistic regression was conducted to test for association between activity level at two years and later revisions. Odds ratio was reported and converted to predicted probability. A Kaplan–Meier curve was plotted to predict implant survival.

Results

The predicted implant survival for UKA was 100.0% at two years and 98.1% at five years. The predicted implant survival for TKA was 99.8% at two years, 98.1% at five years. The difference was not significant (p = 0.410). 2.5% of the UKA underwent revision, one knee in the low and three knees in the moderate activity group, differences between the moderate and high activity group were not significant (p = 0.292). The revision rate in the high activity TKA group was lower than in the low and moderate activity groups (p = 0.008). A higher LEAS two years after surgery was associated with a lower risk for future revision (p = 0.001). A one-point increase in LEAS two years after surgery lowered the odds for undergoing revision surgery by 19%.

Conclusions

The study suggests that participating in sports activity following both UKA and TKA is safe and not a risk factor for revision surgery at a mid-term follow-up. Patients should not be prevented from an active lifestyle following knee replacement.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for conduction this study.

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Authors and Affiliations

  1. Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA

    Laura E. Streck, Carola Hanreich, Cosima S. Boettner & Friedrich Boettner

  2. Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland

    Carola Hanreich

  3. Biostatistics Core, Research Administration, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA

    Agnes D. Cororaton

Authors
  1. Laura E. Streck
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  2. Carola Hanreich
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  4. Cosima S. Boettner
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  5. Friedrich Boettner
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Contributions

Conceputalization: FB, CH; methodology: LS, CH, AC; data collection: LS, CB; statistical analysis: AC, writing—original draft preparation: LS; writing—review and editing: FB, CH, AC, CB; supervision: FB.

Corresponding author

Correspondence to Friedrich Boettner.

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Conflict of interest

FB reports royalties from Smith&Nephew, consultant fees and royalties from Ortho Development Corporation and stock options in AccuJoint, this did not affect the current work. LS, CH, AC and CB declare that they have no financial or non-financial interests to disclose.

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Streck, L.E., Hanreich, C., Cororaton, A.D. et al. Does high activity after total and unicompartmental knee arthroplasty increase the risk for aseptic revision?. Arch Orthop Trauma Surg 143, 5843–5848 (2023). https://doi.org/10.1007/s00402-023-04794-1

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