After a total knee replacement, does a high level of physical activity cause the knee to wear out?
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.
Self-funded or unfunded
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.
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine