Aerobic Physical Fitness and Recreational Sports Participation After Total Knee Arthroplasty: A Systematic Review

CONTEXT: Total knee arthroplasty (TKA) is routinely performed in younger patients who desire to be active in fitness and recreational sports. The activities patients can participate in without symptoms and the level of aerobic fitness routinely maintained are important to investigate. OBJECTIVE: To determine physical activity (PA) and recreational sports resumed after primary TKA, symptoms or limitations with these activities, and the effect of postoperative rehabilitation on achieving fitness and sports goals. DATA SOURCES: A systematic review of the literature from 2005 through 2015 was conducted using the PubMed database. STUDY SELECTION: Original investigations that were conducted at least 1 year after primary TKA and reported the percentage of patients who returned to recreational activities or routinely participated in aerobic PA recommended by the American Heart Association (AHA) were included in this study. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data were extracted as available from 19 eligible studies. Assessment of study quality was rated using the MINORS (Methodological Index for Non-Randomized Studies) instrument. RESULTS: There were 5179 knees (mean age, 67.5 years) followed for a mean 4.8 years postoperatively. Marked variability was present between studies regarding the percentage of patients who resumed recreational activities (34%-100%), most of which were low impact. Only 2 studies used accelerometers to measure PA; these reported a low range (0%-16.5%) of patients who met AHA guidelines. Few studies determined whether symptoms or limitations were experienced during PA. None described rehabilitation exercises or factors that would influence patients’ ability to return to recreational or fitness activities. CONCLUSION: Little evidence is available regarding the effect of TKA on return to recreational and (objectively measured) aerobic fitness. The extent of symptoms or limitations during PA and the long-term effects of such problems remain unclear. Valid predictions cannot be made on factors that may affect return to recreational sports or other aerobic PA after TKA.