Gender and Preoperative Function Predict Physical Activity Levels After Revision Total Knee Arthroplasty

The incidence of revision total knee arthroplasty (TKA) is projected to increase 6-fold worldwide by 2030. As the number of younger, physically active revision TKA patients increases in future, understanding factors influencing postoperative function will be increasingly important to help counsel patients. The primary aim of this study was to examine factors influencing return to physical activity following revision TKA.

Patients who had undergone tibiofemoral revision between 2003 and 2013 at a single UK teaching hospital were retrospectively identified from a prospectively collected arthroplasty database. Preoperative activity level (University of California, Los Angeles [UCLA] score), patient demographics, indication, implant used, and Oxford Knee Scores (OKSs) were recorded in the database. At a mean follow-up of 3.9 years (standard deviation, 2.2), UCLA score, OKS, EuroQol-5 Dimension Score (EQ-5D), satisfaction, complications, and WORQ scores (Work, Osteoarthritis and Joint-Replacement Questionnaire) were sampled via postal questionnaire. Patient experience of complications and related surgery was also identified from healthcare records. Univariate and multivariate analyses were performed.

Responses were received from 112 revision TKAs (112 patients; mean age, 71 years). Mean UCLA activity scores improved from preoperative levels ( P < .001): activity levels improved in 47% of patients with 58% engaging in moderate or more intensive activities (UCLA score ≥5). Postoperative activity level was independently predicted by male gender ( P = .042) and preoperative UCLA score ( P < .001). Increasing social deprivation was associated with inferior UCLA ( P = .005), EQ-5D ( P < .005), and OKS ( P = .006) scores. Indication, implant type, and patient body mass index did not affect functional outcome or satisfaction ( P > .05). Patients <65 years old were more likely to be dissatisfied ( P = .009), and patients aged ≤55 years were more likely to report difficulties with WORQ criteria (P < .05).

Although 90% of patients maintain activity levels following revision TKA, less than half increase levels and this is predicted by male sex and pre-revision activity level.