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Pain Relief and Functional Improvement Remain 20 Years After Knee Arthroplasty

  • Symposium: Papers Presented at the Annual Meetings of The Knee Society
  • Published:
Clinical Orthopaedics and Related Research®



TKA provides demonstrable pain relief and improved health-related quality of life. Yet, a decline in physical function may occur over the long term despite the absence of implant-related problems.


(1) Does pain relief diminish over 20 years after TKA? (2) Does function decline over 20 years in terms of Knee Society function, knee, and walking scores? And (3) what is the patient-reported activity level at most recent followup?

Patients and Methods

We retrospectively identified 1471 patients with 1757 primary cruciate-retaining TKAs implanted between 1975 and 1989 and identified 128 living patients (8.7%) with 171 TKAs. Ninety-three patients were women. We determined Knee Society scores prospectively and UCLA scores retrospectively. Minimum followup was 20 years (average, 21.1 years; range, 20–27 years). Average age at last followup was 82.3 years (range, 45–103 years). Of the 128 patients, 66 (73 TKAs) died after 20-year followup.


Pain scores did not diminish over time (average, 49; range, 20–50). Average knee score was 78 (range, 39–97). Function, stair, and walking scores diminished over time. Average function score was 70 (range, 5–100), primarily due to an average stair score of 35 (range, 0–50); average walking score was 37 (range, 10–50). All but two patients (two TKAs) could negotiate stairs; 95 patients (124 TKAs) could walk at least five blocks; three patients (three TKAs) were housebound. Of the 62 patients still living (98 TKAs), the average UCLA activity score was 8.3 (range, 5–10).


Although aging may cause a gradual decline in physical activity, an improved functional capacity and activity level continue 20 years or more after TKA.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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We thank Philip M. Faris, MD, who along with Merrill A Ritter, MD, and E. Michael Keating, MD, were orthopaedic surgeons for the patient population included in this study.

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Correspondence to John B. Meding MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institutional approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Meding, J.B., Meding, L.K., Ritter, M.A. et al. Pain Relief and Functional Improvement Remain 20 Years After Knee Arthroplasty. Clin Orthop Relat Res 470, 144–149 (2012).

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