Sport after Knee Replacement Surgery – a Review of Sport Habits and Key Surgical Aspects

Abstract

As an increasing number of younger patients are undergoing total knee replacement (TKR) surgery, many wish to participate in sport, but still expect that the implant will survive for a extended period. Most of the current literature shows that patients predominantly participate in low impact activities, both before and after surgery. A few studies show that with appropriate previous experience, high-impact sports are possible and might not result in increased implant failure rates. These include a decrease in point loads on the polyethylene by using more conform bearing surfaces, avoidance of varus component alignment to minimise stresses at the implant bone interface and avoiding patella resurfacing to facilitate activities in deep knee flexion.

A TKR is no longer an absolute contraindication for higher impact activities such as golf, tennis and ski. What is more important than implant specific factors seem to be patient specific factors, including preoperative activity level, and preoperative sport skills.

The current review paper reports on the current sport habits of TKR patients, analyses biomechanical loads on the knee during different sport activities and reports on implant selection and technical considerations for the active patient undergoing TKR.

Keywords

sport - activity - total knee arthroplasty - unicompartmental arthroplasty - patella resurfacing

Publication History

Received: 22 March 2021

Accepted after revision: 12 November 2021

Article published online:
23 February 2022

• Literatur

• 1 Cohrdes C, Mensink GBM, Hölling H. How you live is how you feel? Positive associations between different lifestyle factors, cognitive functioning, and health-related quality of life across adulthood. Qual Life Res 2018; 27: 3281-3292 DOI: 10.1007/s11136-018-1971-8. (PMID: 30136071)
• 2 Healy WL, Iorio R, Lemos MJ. Athletic activity after total knee arthroplasty. Clin Orthop Relat Res 2000; (380) 65-71 DOI: 10.1097/00003086-200011000-00009. (PMID: 11064974)
• 3 Lange T, Schmitt J, Kopkow C. et al. What Do Patients Expect From Total Knee Arthroplasty? A Delphi Consensus Study on Patient Treatment Goals. J Arthroplasty 2017; 32: 2093-2099.e1
• 4 Bourne RB, Chesworth BM, Davis AM. et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468: 57-63 DOI: 10.1007/s11999-009-1119-9. (PMID: 19844772)
• 5 Rupp M, Lau E, Kurtz SM. et al. Projections of Primary TKA and THA in Germany From 2016 Through 2040. Clin Orthop Relat Res 2020; 478: 1622-1633 DOI: 10.1097/CORR.0000000000001214. (PMID: 32168057)
• 6 Grimberg A, Jansson V, Lützner J, Melsheimer O, Morlock M, Steinbrück A. Endoprothesenregister Deutschland (EPRD) – Jahresbericht 2021. https://www.eprd.de/fileadmin/user_upload/Dateien/Publikationen/Berichte/Jahresbericht2021_2021–10–25_F.pdf
• 7 Witjes S, van Geenen RC, Koenraadt KL. et al. Expectations of younger patients concerning activities after knee arthroplasty: are we asking the right questions?. Qual Life Res 2017; 26: 403-417 DOI: 10.1007/s11136-016-1380-9. (PMID: 27492606)
• 8 Witjes S, Gouttebarge V, Kuijer PP. et al. Return to Sports and Physical Activity After Total and Unicondylar Knee Arthroplasty: A Systematic Review and Meta-Analysis. Sports Med 2016; 46: 269-292 DOI: 10.1007/s40279-015-0421-9. (PMID: 26744336)
• 9 Huch K, Müller KA, Stürmer T. et al. Sports activities 5 years after total knee or hip arthroplasty: the Ulm Osteoarthritis Study. Ann Rheum Dis 2005; 64: 1715-1720 DOI: 10.1136/ard.2004.033266. (PMID: 15843453)
• 10 Vu-Han TL, Gwinner C, Perka C. et al. Recommendations for Patients with High Return to Sports Expectations after TKA Remain Controversial. J Clin Med 2020; 10: 54 DOI: 10.3390/jcm10010054. (PMID: 33375242)
• 11 Crawford DA, Adams JB, Hobbs GR. et al. Higher Activity Level Following Total Knee Arthroplasty Is Not Deleterious to Mid-Term Implant Survivorship. J Arthroplasty 2020; 35: 116-120 DOI: 10.1016/j.arth.2019.07.044. (PMID: 31471181)
• 12 Jones DL, Cauley JA, Kriska AM. et al. Physical activity and risk of revision total knee arthroplasty in individuals with knee osteoarthritis: a matched case-control study. J Rheumatol 2004; 31: 1384-1390 (PMID: 15229961)
• 13 Mont MA, Marker DR, Seyler TM. et al. Knee arthroplasties have similar results in high- and low-activity patients. Clin Orthop Relat Res 2007; 460: 165-173 DOI: 10.1097/BLO.0b013e318042b5e7. (PMID: 17310928)
• 14 Bock P, Schatz K, Wurnig C. Physical activity after total knee replacement. Z Orthop Ihre Grenzgeb 2003; 141: 272-276 DOI: 10.1055/s-2003-40081. (PMID: 12822073)
• 15 Healy WL, Sharma S, Schwartz B. et al. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am 2008; 90: 2245-2252 DOI: 10.2106/JBJS.H.00274. (PMID: 18829924)
• 16 Hanreich C, Martelanz L, Koller U. et al. Sport and Physical Activity Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2020; 35: 2274-2285.e1 DOI: 10.1016/j.arth.2020.04.013. (PMID: 32389409)
• 17 Jassim SS, Tahmassebi J, Haddad FS. et al. Return to sport after lower limb arthroplasty – why not for all?. World J Orthop 2019; 10: 90-100 DOI: 10.5312/wjo.v10.i2.90. (PMID: 30788226)
• 18 Hepperger C, Gfoller P, Abermann E. et al. Sports activity is maintained or increased following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26: 1515-1523 DOI: 10.1007/s00167-017-4529-3. (PMID: 28341878)
• 19 Vielgut I, Leitner L, Kastner N. et al. Sports Activity after Low-contact-stress Total Knee Arthroplasty – A long term follow-up study. Sci Rep 2016; 6: 24630 DOI: 10.1038/srep24630. (PMID: 27090945)
• 20 Ho JC, Stitzlein RN, Green CJ. et al. Return to Sports Activity following UKA and TKA. J Knee Surg 2016; 29: 254-259 DOI: 10.1055/s-0035-1551835. (PMID: 26166426)
• 21 Chang MJ, Kim SH, Kang YG. et al. Activity levels and participation in physical activities by Korean patients following total knee arthroplasty. BMC Musculoskelet Disord 2014; 15: 240 DOI: 10.1186/1471-2474-15-240. (PMID: 25030804)
• 22 Lefevre N, Rousseau D, Bohu Y. et al. Return to judo after joint replacement. Knee Surg Sports Traumatol Arthrosc 2013; 21: 2889-2894 DOI: 10.1007/s00167-012-2064-9. (PMID: 22644075)
• 23 Hopper GP, Leach WJ. Participation in sporting activities following knee replacement: total versus unicompartmental. Knee Surg Sports Traumatol Arthrosc 2008; 16: 973-979 DOI: 10.1007/s00167-008-0596-9. (PMID: 18696051)
• 24 Wylde V, Blom A, Dieppe P. et al. Return to sport after joint replacement. J Bone Joint Surg Br 2008; 90: 920-923 DOI: 10.1302/0301-620X.90B7.20614. (PMID: 18591603)
• 25 Walton NP, Jahromi I, Lewis PL. et al. Patient-perceived outcomes and return to sport and work: TKA versus mini-incision unicompartmental knee arthroplasty. J Knee Surg 2006; 19: 112-116 DOI: 10.1055/s-0030-1248089. (PMID: 16642887)
• 26 Chatterji U, Ashworth MJ, Lewis PL. et al. Effect of total knee arthroplasty on recreational and sporting activity. ANZ J Surg 2005; 75: 405-408 DOI: 10.1111/j.1445-2197.2005.03400.x. (PMID: 15943726)
• 27 Bradbury N, Borton D, Spoo G. et al. Participation in sports after total knee replacement. Am J Sports Med 1998; 26: 530-535 DOI: 10.1177/03635465980260041001. (PMID: 9689373)
• 28 Bauman S, Williams D, Petruccelli D. et al. Physical activity after total joint replacement: a cross-sectional survey. Clin J Sport Med 2007; 17: 104-108 DOI: 10.1097/JSM.0b013e3180379b6a. (PMID: 17414477)
• 29 Panzram B, Bertlich I, Reiner T. et al. Cementless unicompartmental knee replacement allows early return to normal activity. BMC Musculoskelet Disord 2018; 19: 18 DOI: 10.1186/s12891-017-1883-8. (PMID: 29343231)
• 30 Schneider BL, Ling DI, Kleebad LJ. et al. Comparing Return to Sports After Patellofemoral and Knee Arthroplasty in an Age- and Sex-Matched Cohort. Orthop J Sports Med 2020; 8: 2325967120957425 DOI: 10.1177/2325967120957425. (PMID: 33088840)
• 31 Waldstein W, Kolbitsch P, Koller U. et al. Sport and physical activity following unicompartmental knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25: 717-728 DOI: 10.1007/s00167-016-4167-1. (PMID: 27209192)
• 32 Plassard J, Masson JB, Malatray M. et al. Factors lead to return to sports and recreational activity after total knee replacement – A retrospective study. SICOT J 2020; 6: 11 DOI: 10.1051/sicotj/2020009. (PMID: 32378511)
• 33 Kleeblad LJ, van der List JP, Zuiderbaan HA. et al. Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26: 1811-1822 DOI: 10.1007/s00167-017-4817-y. (PMID: 29185005)
• 34 Jones DL, Bhanegaonkar AJ, Billings AA. et al. Differences between actual and expected leisure activities after total knee arthroplasty for osteoarthritis. J Arthroplasty 2012; 27: 1289-1296 DOI: 10.1016/j.arth.2011.10.030. (PMID: 22480521)
• 35 Mont MA, Marker DR, Seyler TM. et al. High-impact sports after total knee arthroplasty. J Arthroplasty 2008; 23: 80-84 DOI: 10.1016/j.arth.2008.04.018. (PMID: 18722307)
• 36 Mayr HO, Reinhold M, Bernstein A. et al. Sports activity following total knee arthroplasty in patients older than 60 years. J Arthroplasty 2015; 30: 46-49 DOI: 10.1016/j.arth.2014.08.021. (PMID: 25304937)
• 37 Van Rossom S, Wesseling M, Smith CR. et al. The influence of knee joint geometry and alignment on the tibiofemoral load distribution: A computational study. Knee 2019; 26: 813-823 DOI: 10.1016/j.knee.2019.06.002. (PMID: 31255528)
• 38 Halder A, Kutzner I, Graichen F. et al. Influence of limb alignment on mediolateral loading in total knee replacement: in vivo measurements in five patients. J Bone Joint Surg Am 2012; 94: 1023-1029 DOI: 10.2106/JBJS.K.00927. (PMID: 22637208)
• 39 Heinlein B, Kutzner I, Graichen F. et al. ESB Clinical Biomechanics Award 2008: Complete data of total knee replacement loading for level walking and stair climbing measured in vivo with a follow-up of 6–10 months. Clin Biomech (Bristol, Avon) 2009; 24: 315-326 DOI: 10.1016/j.clinbiomech.2009.01.011. (PMID: 19285767)
• 40 D’Lima DD, Steklov N, Patil S. et al. The Mark Coventry Award: in vivo knee forces during recreation and exercise after knee arthroplasty. Clin Orthop Relat Res 2008; 466: 2605-2611 DOI: 10.1007/s11999-008-0345-x. (PMID: 18563502)
• 41 Kutzner I, Heinlein B, Graichen F. et al. Loading of the knee joint during ergometer cycling: telemetric in vivo data. J Orthop Sports Phys Ther 2012; 42: 1032-1038
• 42 Ericson M. On the biomechanics of cycling. A study of joint and muscle load during exercise on the bicycle ergometer. Scand J Rehabil Med Suppl 1986; 16: 1-43 (PMID: 3468609)
• 43 Lynch JT, Perriman DM, Scarvell JM. et al. The influence of total knee arthroplasty design on kneeling kinematics: a prospective randomized clinical trial. Bone Joint J 2021; 103-B: 105-112 DOI: 10.1302/0301-620X.103B1.BJJ-2020-0958.R1. (PMID: 33380183)
• 44 Sharma A, Dennis DA, Zingde SM. et al. Femoral condylar contact points start and remain posterior in high flexing patients. J Arthroplasty 2014; 29: 945-949 DOI: 10.1016/j.arth.2013.09.037. (PMID: 24157225)
• 45 Sharma A, Leszko F, Komistek RD. et al. In vivo patellofemoral forces in high flexion total knee arthroplasty. J Biomech 2008; 41: 642-648 DOI: 10.1016/j.jbiomech.2007.09.027. (PMID: 17983624)
• 46 Courtney PM, Lee GC. Early Outcomes of Kinematic Alignment in Primary Total Knee Arthroplasty: A Meta-Analysis of the Literature. J Arthroplasty 2017; 32: 2028-2032.e1 DOI: 10.1016/j.arth.2017.02.041. (PMID: 28341278)
• 47 Zhang Z, Liu C, Li Z. et al. Residual Mild Varus Alignment and Neutral Mechanical Alignment Have Similar Outcome after Total Knee Arthroplasty for Varus Osteoarthritis in Five-Year Follow-Up. J Knee Surg 2020; 33: 200-205 DOI: 10.1055/s-0038-1677497. (PMID: 30650442)
• 48 Klasan A, de Steiger R, Holland S. et al. Similar Risk of Revision After Kinematically Aligned, Patient-Specific Instrumented Total Knee Arthroplasty, and All Other Total Knee Arthroplasty: Combined Results From the Australian and New Zealand Joint Replacement Registries. J Arthroplasty 2020; 35: 2872-2877 DOI: 10.1016/j.arth.2020.05.065. (PMID: 32620297)
• 49 Ritter MA, Davis KE, Meding JB. et al. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 2011; 93: 1588-1596 DOI: 10.2106/JBJS.J.00772. (PMID: 21915573)
• 50 Howell SM, Papadopoulos S, Kuznik K. et al. Does varus alignment adversely affect implant survival and function six years after kinematically aligned total knee arthroplasty?. Int Orthop 2015; 39: 2117-2124 DOI: 10.1007/s00264-015-2743-5. (PMID: 25823516)
• 51 Streit MR, Streit J, Walker T. et al. Minimally invasive Oxford medial unicompartmental knee arthroplasty in young patients. Knee Surg Sports Traumatol Arthrosc 2017; 25: 660-668 DOI: 10.1007/s00167-015-3620-x. (PMID: 25957605)
• 52 Wong J, Steklov N, Patil S. et al. Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty. J Orthop Res 2011; 29: 347-353 DOI: 10.1002/jor.21221. (PMID: 20882595)
• 53 Berend ME, Ritter MA, Meding JB. et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004; (428) 26-34 DOI: 10.1097/01.blo.0000148578.22729.0e. (PMID: 15534515)
• 54 Julin J, Jämsen E, Puolakka T. et al. Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop 2010; 81: 413-419 DOI: 10.3109/17453674.2010.501747. (PMID: 20809740)
• 55 Currier JH, Van Citters DW. Knee Wear. In: Scott WN. Insall & Scott Surgery of the Knee. Philadelphia, Pa.: Elsevier Churchill Livingstone; 2018: 323-328
• 56 Nam D, Lawrie CM, Salih R. et al. Cemented Versus Cementless Total Knee Arthroplasty of the Same Modern Design: A Prospective, Randomized Trial. J Bone Joint Surg Am 2019; 101: 1185-1192 DOI: 10.2106/JBJS.18.01162. (PMID: 31274720)
• 57 Papas PV, Congiusta D, Cushner FD. Cementless versus Cemented Fixation in Total Knee Arthroplasty. J Knee Surg 2019; 32: 596-599 DOI: 10.1055/s-0039-1678687. (PMID: 30822792)
• 58 Brown TE, Harper BL, Bjorgul K. Comparison of cemented and uncemented fixation in total knee arthroplasty. Orthopedics 2013; 36: 380-387 DOI: 10.3928/01477447-20130426-10. (PMID: 23672897)
• 59 Sharkey PF, Lichstein PM, Shen C. et al. Why are total knee arthroplasties failing today--has anything changed after 10 years?. J Arthroplasty 2014; 29: 1774-1778
• 60 Baker-LePain JC, Lane NE. Role of bone architecture and anatomy in osteoarthritis. Bone 2012; 51: 197-203 DOI: 10.1016/j.bone.2012.01.008. (PMID: 22401752)
• 61 Newman JM, Sodhi N, Dekis JC. et al. Survivorship and Functional Outcomes of Cementless versus Cemented Total Knee Arthroplasty: A Meta-Analysis. J Knee Surg 2020; 33: 270-278 DOI: 10.1055/s-0039-1678525. (PMID: 30736055)
• 62 Zahiri CA, Schmalzried TP, Szuszczewicz ES. et al. Assessing activity in joint replacement patients. J Arthroplasty 1998; 13: 890-895 DOI: 10.1016/s0883-5403(98)90195-4. (PMID: 9880181)
• 63 Krug S, Jordan S, Mensink GB. et al. Physical activity: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56: 765-771 DOI: 10.1007/s00103-012-1661-6. (PMID: 23703496)
• 64 Bercovy M, Langlois J, Beldame J. et al. Functional Results of the ROCC(R) Mobile Bearing Knee. 602 Cases at Midterm Follow-Up (5 to 14 Years). J Arthroplasty 2015; 30: 973-979 DOI: 10.1016/j.arth.2015.01.003. (PMID: 25686786)