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Impacts of Knee Arthroplasty on Activity Level and Knee Function in Young Patients: A Systematic Review
The annual demand for knee arthroplasty has been steadily rising, particularly in younger patients. The primary objective of this systematic review was to determine the impact of knee arthroplasties on knee function and activity levels in young (≤55 years) patients. A PubMed search from inception (1977) to March 2022 to identify eligible studies produced 640 peer-reviewed studies for consideration. A total of 18 studies including 4,186 knee arthroplasties in 3,200 patients (mean patient age at the time of surgery: 47.4 years, range: 18–55 years) were ultimately included for analysis. Mean final follow-up (FFU) duration was 5.8 years (range: 2–25.1 years). Mean FFU improvement in Knee Society Clinical Score was 48.0 (1,625 knees, range: 20.9–69.0), Knee Society Function Score was 37.4 (1,284 knees, range: 20–65). Mean FFU for the Tegner and Lysholm activity scale was 2.8 (4 studies, 548 knees, range: 0.7–4.2); University of California Los Angeles Physical Activity Questionnaire score was 2.8 (3 studies, 387 knees, range: 1.2–5); lower extremity activity scale was 1.84 (529 knees). The available evidence suggest that young patients typically realize sustained improvements in knee function compared to preoperative levels; however, these improvements do not typically translate into a return to desired activity levels or quality of life, and this patient population should expect a higher and earlier risk for revision than their older counterparts. Further research, including robust registry data, is needed to establish evidence-based indications, expectations, and prognoses for outcomes after knee arthroplasty in young and active patients.
Received: 12 June 2023
Accepted: 14 September 2023
Accepted Manuscript online:
15 September 2023
Article published online:
12 October 2023
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- 1 Fuller SI, Cohen JS, Malyavko A. et al. Knee arthroplasty utilization trends from 2010 to 2019. Knee 2022; 39: 209-215
- 2 Kumar A, Gori Y, Kumar A, Meena C, Dutt N. Advanced Materials for Biomedical Applications. USA: CRC Press (Taylor & Francis); 2022
- 3 Losina E, Katz JN. Total knee arthroplasty on the rise in younger patients: are we sure that past performance will guarantee future success?. Arthritis Rheum 2012; 64 (02) 339-341
- 4 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
- 5 Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009; 467 (10) 2606-2612
- 6 Klug A, Gramlich Y, Rudert M. et al. The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years. Knee Surg Sports Traumatol Arthrosc 2021; 29 (10) 3287-3298
- 7 Tay ML, Young SW, Frampton CM, Hooper GJ. The lifetime revision risk of unicompartmental knee arthroplasty. Bone Joint J 2022; 104-B (06) 672-679
- 8 Walker-Santiago R, Tegethoff JD, Ralston WM, Keeney JA. Revision total knee arthroplasty in young patients: higher early reoperation and rerevision. J Arthroplasty 2021; 36 (02) 653-656
- 9 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
- 10 Sterne JA, Hernán MA, Reeves BC. et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919
- 11 Sterne JAC, Savović J, Page MJ. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898
- 12 Eckhard L, Munir S, Wood D. et al. Minimal important change and minimum clinically important difference values of the KOOS-12 after total knee arthroplasty. Knee 2021; 29: 541-546
- 13 Khalil LS, Darrith B, Franovic S, Davis JJ, Weir RM, Banka TR. Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Short Forms Demonstrate Responsiveness in Patients Undergoing Knee Arthroplasty. J Arthroplasty 2020; 35 (06) 1540-1544
- 14 Lizaur-Utrilla A, Martinez-Mendez D, Miralles-Muñoz FA, Marco-Gómez L, Lopez-Prats FA. Comparable outcomes after total knee arthroplasty in patients under 55 years than in older patients: a matched prospective study with minimum follow-up of 10 years. Knee Surg Sports Traumatol Arthrosc 2017; 25 (11) 3396-3402
- 15 Keeney JA, Nunley RM, Wright RW, Barrack RL, Clohisy JC. Are younger patients undergoing TKAs appropriately characterized as active?. Clin Orthop Relat Res 2014; 472 (04) 1210-1216
- 16 Long WJ, Bryce CD, Hollenbeak CS, Benner RW, Scott WN. Total knee replacement in young, active patients: long-term follow-up and functional outcome: a concise follow-up of a previous report. J Bone Joint Surg Am 2014; 96 (18) e159
- 17 Charette RS, Sloan M, DeAngelis RD, Lee GC. Higher rate of early revision following primary total knee arthroplasty in patients under age 55: a cautionary tale. J Arthroplasty 2019; 34 (12) 2918-2924
- 18 Lange JK, Lee YY, Spiro SK, Haas SB. Satisfaction rates and quality of life changes following total knee arthroplasty in age-differentiated cohorts. J Arthroplasty 2018; 33 (05) 1373-1378
- 19 Krych AJ, Reardon P, Sousa P, Pareek A, Stuart M, Pagnano M. Unicompartmental knee arthroplasty provides higher activity and durability than valgus-producing proximal tibial osteotomy at 5 to 7 years. J Bone Joint Surg Am 2017; 99 (02) 113-122
- 20 Greco NJ, Lombardi Jr AV, Price AJ, Berend ME, Berend KR. Medial mobile-bearing unicompartmental knee arthroplasty in young patients aged less than or equal to 50 years. J Arthroplasty 2018; 33 (08) 2435-2439
- 21 Kamikovski I, Dobransky J, Dervin GF. The clinical outcome of patellofemoral arthroplasty vs total knee arthroplasty in patients younger than 55 years. J Arthroplasty 2019; 34 (12) 2914-2917
- 22 Kim YH, Park JW, Lim HM, Park ES. Cementless and cemented total knee arthroplasty in patients younger than fifty five years. Which is better?. Int Orthop 2014; 38 (02) 297-303
- 23 Mont MA, Lee CW, Sheldon M, Lennon WC, Hungerford DS. Total knee arthroplasty in patients ≤50 years old. J Arthroplasty 2002; 17 (05) 538-543
- 24 Lonner JH, Hershman S, Mont M, Lotke PA. Total knee arthroplasty in patients 40 years of age and younger with osteoarthritis. Clin Orthop Relat Res 2000; (380) 85-90
- 25 Gioe TJ, Novak C, Sinner P, Ma W, Mehle S. Knee arthroplasty in the young patient: survival in a community registry. Clin Orthop Relat Res 2007; 464 (464) 83-87
- 26 Lizaur-Utrilla A, Miralles-Muñoz FA, Lopez-Prats FA. Similar survival between screw cementless and cemented tibial components in young patients with osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2014; 22 (07) 1585-1590
- 27 Odland AN, Callaghan JJ, Liu SS, Wells CW. Wear and lysis is the problem in modular TKA in the young OA patient at 10 years. Clin Orthop Relat Res 2011; 469 (01) 41-47
- 28 Kim YH, Kim JS, Choe JW, Kim HJ. Long-term comparison of fixed-bearing and mobile-bearing total knee replacements in patients younger than fifty-one years of age with osteoarthritis. J Bone Joint Surg Am 2012; 94 (10) 866-873
- 29 Belmont Jr PJ, Heida K, Keeney JA, Hamilton W, Burks R, Waterman BR. Return to work and functional outcomes following primary total knee arthroplasty in U.S. military servicemembers. J Arthroplasty 2015; 30 (06) 968-972
- 30 Radhakrishnan GT, Magan A, Kayani B, Asokan A, Ronca F, Haddad FS. Return to sport after unicompartmental knee arthroplasty: a systematic review and meta-analysis. Orthop J Sports Med 2022; 10 (03) 23 259671221079285
- 31 Hanreich C, Martelanz L, Koller U, Windhager R, Waldstein W. Sport and physical activity following primary total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 2020; 35 (08) 2274-2285.e1
- 32 Bayliss LE, Culliford D, Monk AP. et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-basd cohort study. Lancet 2017; 389 (10077): 1424-1430
- 33 Duffy GP, Crowder AR, Trousdale RR, Berry DJ. Cemented total knee arthroplasty using a modern prosthesis in young patients with osteoarthritis. J Arthroplasty 2007; 22 (06) 67-70 DOI: 10.1016/j.arth.2007.05.001.
- 34 Tai CC, Cross MJ. Five- to 12-year follow-up of a hydroxyapatite-coated, cementless total knee replacement in young, active patients. J. Bone Joint Surgery Brit volume 2006; ;88-B (09) 1158-1163 DOI: 10.1302/0301-620X.88B9.17789.
- 35 Goh GS, Bin Abd Razak HR, Tay DK, Chia SL, Lo NN, Yeo SJ. Unicompartmental knee arthroplasty achieves greater flexion with no difference in functional outcome, quality of life, and satisfaction vs total knee arthroplasty in patients younger than 55 years. A propensity score-matched cohort analysis. J Arthroplasty 2018; Feb; 33 (02) 355-361 DOI: 10.1016/j.arth.2017.09.022.
- 36 Ritter MA, Lutgring JD, Davis KE, Faris PM, Berend ME. Total knee arthroplasty effectiveness in patients 55 years old and younger: Osteoarthritis vs. rheumatoid arthritis. The Knee 2007; 14 (01) 9-11 DOI: 10.1016/j.knee.2006.10.010.