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Question clinique
After a total knee replacement, does a high level of physical activity cause the knee to wear out?
L’Essentiel
A high physical activity level is not associated with an increase in the need for total knee replacement revisions and may be protective. The authors opine that only people with prior-to-surgery experience in technically demanding sports, such as tennis or downhill skiing, should engage in them after surgery. They render no opinions on break dancing, Irish clogging, or skateboarding. 1a
Référence
Plan de l'etude: Meta-analysis (other)
Financement: Self-funded or unfunded
Cadre: Various (meta-analysis)
Sommaire
These authors followed PRISMA guidelines for systematic reviews and assembled a total of 6 cohort and case-control studies published in 1 of 3 languages. Overall, 4811 procedures were performed in 4263 patients, with a mean follow-up of 4 to 12 years. The studies comprised patients undergoing total knee arthroplasty for whom recreational and sports activity were measured and for whom surgical revisions were tracked over time. The authors excluded fracture-related replacements and simultaneous bilateral knee replacements. One investigator extracted the data, and a second investigator checked the data. Two investigators independently assessed the research for risk of bias, which was moderate for 5 of the studies and high for 1 study. There was no association between high physical activity and an increased risk of revision surgery (level of certainty: very low) or revision surgery due to loosening (level of certainty: moderate). A single study of 2038 participants found a protective effect of high physical activity on survivorship (odds ratio 2.4; 95% CI 1.2 - 4.7; level of certainty: low). All physical activity — from swimming to higher impact running and tennis — was lumped together.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
Knees & Exercise & TKA
Useless
thr durability
give er
no
none
Knee replacement results
reassuring.
Impact assessment i8
Very good