Comparing Return to Sports After Patellofemoral and Knee Arthroplasty in an Age- and Sex-Matched Cohort

Abstract

Background: Return to sports is an important outcome in ensuring patient satisfaction after knee-replacement surgery. However, few studies have directly compared unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), and patellofemoral arthroplasty (PFA). Hypothesis: TKA will result in lower rates of return to sports than either UKA and PFA due to increased complexity and invasiveness. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent UKA, TKA, or PFA with 1 to 2 years of follow-up were sent a questionnaire regarding return to sports, satisfaction with return to sports, pain, the University of California, Los Angeles activity scale, and the High Activity Arthroplasty Score (HAAS). The patients who underwent either TKA or UKA were matched 2:1 with regard to age and sex to patients who underwent PFA. Differences were compared using analysis of variance, t tests, and chi-square tests. Results: A total of 202 patients were eligible. After matching, the final cohort consisted of 23 PFA patients, 46 UKA patients, and 46 TKA patients. The majority of patients were female (87%), and the mean ± SD age was 56 ± 9.1 years. The UKA group had higher HAAS values than the TKA group pre- and postoperatively (9.9 vs 7.1 [ P = .001] and 12.4 vs 9.5 [ P < .001], respectively). Patients with UKA had higher rates of return to sports after surgery than those with TKA or PFA (UKA, 80.5%; TKA, 71.7%; PFA, 69.5%; P = 0.08). In addition, the UKA group had the highest satisfaction with this outcome. Improvement between pre- and postoperative scores was similar in all 3 groups. Conclusion: Patients who underwent UKA reported better activity scores and return-to-sports rates than patients who had TKA and PFA. No differences were found in improvement after surgery, suggesting that preoperative differences were reflected postoperatively. These findings inform shared decision making and can help to manage patient expectations after surgery.

Shift to low-impact sports and recreational activities following total knee replacement

“…Eighty-six percent of patients returned to their previous level of activity or a higher level than that prior to surgery. 11 In the study by Schneider et al, 7 25 patients on 46 (54.3%) returned to sports at the same or higher level of impact after TKR, with 67.4% satisfied after surgery. In the study by Hepperger et al 19 on 200 patients who underwent TKR, sport participation and Tegner activity level significantly increased 2 years after surgery compared to preoperative status.…”

“… 18 The decrease in high-impact sports is consistent with the results reported in previous studies. 7 , 11 , 12 The shift from high- to low-impact activities might explain the increase in Tegner score rather than the TKR being the main influencing factor.…”

“…1 At present, return to physical activity constitutes an important factor after knee replacement surgery, as the capacity of resuming sporting activities comparable to those engaged prior to surgery, represents a major concern among sportsmen undergoing knee prosthesis implantation. 2 Patients are nowadays more likely to expect to return to sporting activities they practiced prior to impairments due to knee osteoarthritis (OA), [3][4][5][6][7][8] and recommendations for patients with high return to sports expectations after total knee replacement (TKR) remain controversial. 9,10 Commonly reported outcome measures following joint replacement are point scales, but limited information exist concerning return to sport rate since at present not much literature exists regarding return to physical activities following knee joint replacement.…”

“…At present, return to physical activity constitutes an important factor after knee replacement surgery, as the capacity of resuming sporting activities comparable to those engaged prior to surgery, represents a major concern among sportsmen undergoing knee prosthesis implantation. 2 Patients are nowadays more likely to expect to return to sporting activities they practiced prior to impairments due to knee osteoarthritis (OA), 3 – 8 and recommendations for patients with high return to sports expectations after total knee replacement (TKR) remain controversial. 9 , 10 …”

Sport mit Knieprothese – Wieviel Sport ist möglich und was gilt es zu beachten ?

“…One study specifically compared patients with unicondylar knee arthroplasties vs. TKAs vs. patellofemoral replacements (PFE). Unicondylar knee arthroplasty patients had higher postoperative activity scores, but this patient group already had higher preoperative scores [8,30]. The meta-analysis by Witjes et al suggests that unicondylar knee arthroplasty patients return to sports at higher rates.…”