Return to Sport After Total Knee Replacements?

Posted on by BMJ

By Alexander Wood

knee run

The number of total knee replacements (TKR) performed annually has doubled over the last decade1. TKR is common in the young population2 and an increasing number of elderly patients are playing sport and sustaining sports related injuries3. Considering the above factors combined with improvements in life expectancy and in overall general health4, more patients will likely require or demand a knee replacement, and question the likelihood of returning to sport.

Return to sport post TKR

Whilst a total knee replacement does not preclude a return to sport, research suggests that patients can return to light sporting activities like walking, swimming, golf, yoga and cycling5. Despite this, research also suggests that far less people who regularly participate in sports prior to surgery, participate in sports after surgery4,6,7, and that only around one in twenty patients will return to sports after surgery6. Five years after a TKR, one in twenty patients reported participating in more than 2 hours of sport, compared to almost one in ten prior to surgery4. Notably, this effect may be associated with other age related impairments8.Whilst it may be possible to return to sport after a TKR, it should not be a primary reason for individuals to undergo a TKR; the evidence suggests that sports participation decreases rather than increases.

Will I be able to run or ski post TKR?

Running or skiing post TKR is not advised8 although this is currently debatable.  However, only 1-2% of patients participate in these activities post TKR4.  The advice from the American Academy of Orthopaedic Surgeons10 is to avoid activities like jogging, racquetball and skiing and the NHS strongly advises against running and jumping11.

Should I participate in any sport after a TKR?

Whilst any sport may increase the wear on implants, the benefits of aerobic activity outweigh these possibilities and therefore health practitioners should encourage patients to participate in aerobic activity post TKR12.

Summary

Elderly patients are increasingly participating in sport and consequently the number of  knee replacements are on the rise.  Whilst the polyethylene used in total knee replacements and their survivorship has improved, current advice for patients is that activity level is not likely to increase after a TKR. Lastly, encourage patients to perform aerobic exercise post TKR surgery, but avoid high impact sports.

References

  1. Weinstein AM, Rome BN, Reichmann WM, Collins JE, Burbine SA, Thornhill TS, Wright J, Katz JN Losina E. Estimating the burden of total knee Replacement in the United States. JBJS AM 2013 6;95(5):385-92
  2. Wood AM, Keenan A, Arthur C, Aitken S, Walmsley P, Brenkel I, “The Functional Outcome of Total Knee Replacement in Young Patients: A 10-Year Matched Case Control Study,” Open Journal of Orthopedics, Vol. 3 No. 2, 2013, pp. 128-132. doi: 4236/ojo.2013.32024.
  3. Court-Brown CM, Wood AM, Aitken SA. The epidemiology of acute sports-related fractures in adults. Injury 2008; 39(12):1365-72
  4. Huch K, Muller KAC, Sturmer T, Brenner H, Puhl W, Gunther KP. Sports activities 5 years after total knee or hip arthroplasty: the ulm osteoarthritis study. Ann Rhem Dis 2005;64:1715-1720
  5. http://www.healthline.com/health/total-knee-replacement-surgery/sports-activities-after#2(Last Accessed 14 August 2014)
  6. Bradbury N, Borton D, Spoo G, Cross MJ. Participation in Sports After Total Knee Replacement. AJSM 1998:26(4);530-535
  7. Hopper GP, Leach WJ. Participation in sporting activities following knee replacement: total versus unicompartmental. Knee Surgery, Sports Traumatology, Arthroscopy. 2008;16(10):973-979
  8. Zahiri CA, Schmalzried TP, Szudzczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty 1998;13:890-5
  9. Kuster MS, Spalinger E, Blanksby BA, Gachter A. Endurance sports after total knee replacement; a biochemical investigation. Med Sci Sports Exerc 2000;32:721-4
  10. http://orthoinfo.aaos.org/topic.cfm?topic=a00357 (Last Accessed 14 August 2014)
  11. http://www.nhslothian.scot.nhs.uk/Services/A-Z/Orthopaedics/KneeConditions/TotalKneeReplacementPatientsGuide.pdf (Last Accessed 14 August 2014)
  12. McGrory BJ, Stuart MJ, Sim FH. Participation in Sports after Hip and Knee Arthroplasty: Review of Literature and Survey of Surgeon Preferences. Mayo Clin Proc 1995;70:342-348

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Alexander Wood BSc MB ChB, MSc (SEM) FRCSEd (T&O)

ST8 Trauma and Orthopaedics, Royal Victoria Hospital Newcastle UK

Correspondence: drsandywood@googlemail.com

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