Return to sports is possible after knee arthroplasty, but seems more likely after unicondylar arthroplasty than after total knee arthroplasty, particularly concerning higher-impact types of sports. |
In the included studies, little attention was given to possible confounding factors, such as preoperative sports level, restricting comorbidities, and negative advice from surgeons. |
We recommend generalising the definition of the assessment of the preoperative sports level to the ‘presymptomatic phase’, as this plays an important role in defining return to sports percentages. |
1 Introduction
2 Methods
2.1 Search Strategy
2.2 Inclusion Criteria and Study Selection
2.3 Methodological Quality
2.4 Data Extraction
2.5 Pooling Data
3 Results
3.1 Literature Search
3.2 Included Studies
Study | Study design | Study population | Rehabilitation protocol | Outcome measures | Preoperative (pre) activity + definition | Postoperative (post) activity | RTS + time to RTS | Confounding factors |
---|---|---|---|---|---|---|---|---|
Argenson et al. (2008) France [42] | Prospective Follow-up: 3 y (range 2–4) | Non-selected 455 pts, 516 KAs 146 (33 %) M 299 (67 %) F Mean age: 71.6 y (range 22–96) Mean BMI: 28.3 kg/m2 (range 16–44) Co: ? OA: 92 % primary, 2 % RA, 6 % other | Full weight bearing | General (n = 412) | Regarding sports: Inactive: 34 % Limited in ADL: 54 % Active in work/sports: 9 % Unknown: 3 % | Sports level: =14 % >72 % <14 % Mainly walking, hiking, swimming, exercising, cycling, golfing | 86 % Time to RTS: 6 mo (±4) | Age Sex BMI Pre sports level Complications Expectations Partly mentioned, not adjusted for |
UCLA (n = 412) | Unknown Pre-sports activity level at time of surgery | 6.9 (±1.6) | ||||||
Bock et al. (2003) Austria [41] | Cross-sectional Follow-up: 74 mo (24–156) Language: German | Selected, <65 y 138 pts, 184 KAs 28 (20.3 %) M 110 (79.7 %) F Mean age: 55.3 y (21–65) Mean BMI: ? Co: 7 pts (abcess, spondylodiscitis, sciatica, CVA, kidney, cardiopulmonary) OA: Primary 63 % Polyarthritis 28 % Post-traumatic 4 % Inflammatory 1.4 % Other 3.4 % | Uncemented: 3-point gait during 6 wks Cemented: 4-point gait pattern 6 wks After 6 wks: similar stepwise mobilisation for every pt | General active (n = 138) Sports participation: |
n = 111 (80.4 %) |
n = 104 (75.4 %) |
n = 99 (89 %) RTS% | Age Co-morbidities Pre sports level Mentioned in results or discussion, not adjusted for |
- Walking | 99 | 99 + 4 = 103 | 100 | |||||
- Cycling | 47 | 20 | 42.6 | |||||
- Swimming | 43 | 37 + 1 = 38 | 86.0 | |||||
- Hiking | 28 | 18 | 64.3 | |||||
- Skiing | 7 | 1 | 14.3 | |||||
- Langlauf | 4 | 2 | 50 | |||||
- Mountain climbing | 4 | 0 | 0 | |||||
- Tennis | 2 | 0 | 0 | |||||
- soccer | 3 | 0 | 0 | |||||
- Stationary biking | 0 | 7 | ? | |||||
- Aquajogging | 0 | 1 | ? | |||||
General: 12 pts stopped post, 5 pts restarted sports (4 × walking, 1 × swimming) | Active yes/no | |||||||
UCLA | Unknown | 5.9/2.9 | ||||||
Tegner | Unknown | 3.9/1.8 | ||||||
No information concerning definition pre sports | Time to RTS: 4.7 mo (3–15) | |||||||
Bradbury et al. (1998) UK [50] | Cross-sectional Follow-up: 5 y (3–7) | Non-selected 160 pts, 208 KAs [RTS unilateral 61 %, bilateral (simultaneous TKA) 75 %] 30 (8 %) M 339 (92 %) F Mean age: 68 y (27–87) Mean BMI: ? Co: 55 co-morbidities that limited their activity (pre) → no RTS OA: 142/159 (89.3 %) primary | Early post-op mobilisation and full weight bearing was permitted as tolerated with supervision of physical therapist | General active (n = 160) |
n = 79 (49.4 %) |
n = 51 (31.9 %) | 65 % | Co-morbidities − Pre sports level + Complications − Psychosocial (motivation) + Surgeon advice: all pts were advised that high-impact sports were not recommended and low-impact sports were acceptable |
In last year before surgery | 56* | 43/56 (77 %) | ||||||
Sports participation: | RTS% | |||||||
- Golf | 51 | 39 | 76.5 | |||||
- Bowls | 32 | 29 | 91 | |||||
- Tennis | 30 | 6 | 20 | |||||
- Cycling | 1 | 4 | >100 | |||||
- Croquet | 4 | 4 | 100 | |||||
- Golf + cart | 3 | 3 | 100 | |||||
- Cricket | 3 | 2 | 66.7 | |||||
- Body surf | 1 | 1 | 100 | |||||
- Bush walk | 2 | 1 | 50 | |||||
- Tai chi | 0 | 1 | ? | |||||
- Rugby, skiing, football, running | 1 | 0 | 0 % | |||||
No information concerning definition pre sports | ||||||||
Chang et al. (2014) Korea [49] | Retrospective survey Follow-up: 2 y (1–3) | Non-selected 369 pts 30 (8 %) M 339 (92 %) F Mean age: 68.8 y (50–83) Mean BMI: 27.4 kg/m2 (19.3–39.1) Co: 50 (14 %) medical limitation OA: 331 (95 %) primary | No description | Regulara activity (n = 369) | 71 % | 76 % | +5 %* | Sex Age BMI Pre sports level Recall bias All suggested as possible confounders and ANCOVA of age, BMI and preop level, but results not presented |
Sports participation: | RTS% | |||||||
- Walking | 177 | 221 | >100 | |||||
- Swimming | 79 | 85 | >100 | |||||
- Bicycling | 60 | 80 | >100 | |||||
- Hiking | 34 | 22 | 65 | |||||
- Gymnastics | 14 | 17 | >100 | |||||
- Badminton | 9 | 6 | 67 | |||||
- Running | 7 | 5 | 74 | |||||
- Golf | 7 | 2 | 26 | |||||
- Table tennis | 5 | 3 | 57 | |||||
- Gateball | 3 | 4 | >100 | |||||
UCLA mean subscore | 4.5
N (%) | 4.8
N (%) | ∆ 0.3* | |||||
UCLA <4 | 90 (24) | 39 (11) | ||||||
UCLA 4–6 | 240 (65) | 296 (80) | ||||||
UCLA >6 | 36 (11) | 34 (9) | ||||||
VAS satisfaction in general (post) | Active yes/no 7.9/7.2 | ∆ 0.7#
| ||||||
VAS satisfaction about activity (post) | 7.5/6.3 | ∆ 1.2#
| ||||||
No information concerning definition pre sports | ||||||||
Chatterji et al. (2005) Australia [40] | Cross-sectional survey Follow-up: ? ‘between 1 and 2 y post’ | Non-selected 144 pts 64 (44 %) M 80 (56 %) F Mean age: 70.8 y (SD 10.4) Mean BMI: ? Co: ? OA: 136 (94 %) primary | Post-PT was carried out in the hospital until discharge, then performed their own rehabilitation, as instructed prior to discharge Only occasionally was formal out-pt PT needed (no further details provided) | 1 or more sports (n = 144) Sports participation: |
n = 122 (85%) |
n = 108 (75 %) | 81 % Same sport 69 % RTS%/time wks | Sex: M > F Men were significantly more sport oriented than women, both pre- and postoperative |
- Volleyball | 0 | 1 | ?/− | |||||
- Squash | 1 | 0 | 0/− | |||||
- Croquet | 2 | 1 | 50/5 | |||||
- Badminton | 1 | 1 | 100/6 | |||||
- Rowing | 3 | 0 | 0/− | |||||
- Snow skiing | 1 | 0 | 0/− | |||||
- Hiking | 2 | 0 | 0/− | |||||
- Jogging | 4 | 0 | 0/− | |||||
- Aqua aerobics | 8 | 12 | >100/6.9 | |||||
- Bush walking | 8 | 3 | 38/8 | |||||
- Tennis | 14 | 2 | 14/30 | |||||
- Fishing | 18 | 12 | 67/26 | |||||
- Cycling | 10 | 5 | 50/12.5 | |||||
- Exercise classes | 12 | 9 | 75/12 | |||||
- Bowling | 22 | 17 | 77/18.3 | |||||
- Golf | 19 | 9 | 47/13 | |||||
- Swimming | 27 | 22 | 81/13.1 | |||||
- Exercise walking | 94 | 104 | >100/8.7 | |||||
Grimby score | Unknown | 2.8 | ||||||
Mean sport score (n. of sports) | N. of sports: −20 % −12 % ∆ 0.7* | |||||||
- Overall | 1.76 | 1.41 | ||||||
- Sporting patients | 2.1 | 1.8 | ||||||
- M | 2.4 | 1.7 | ||||||
- F | 1.4 | 1.1 | ||||||
Perceived effect of TKA in sports function (n = 106) (meaning: 1 = improved to 10 = stopped completely) | All 4.3 (SD 3.4) M 4.2 (SD 3.3) F 4.7 (SD 3.6) | |||||||
No information concerning definition pre sports | ||||||||
Diduch et al. (1997) USA [54] | Cross-sectional Follow-up: 8 y (3–18) | Selected, unrevised, <55 y (post-traumatic) OA 84 pts, 103 KAs 29 (35 %) M 55 (65 %) F Mean age: 51 y (22–55) Mean BMI: ? Co: ? OA: 64 % primary, 36 % post-traumatic | No description | Sports participation |
N (%) of n = 80 | No information Only comment concerning usual cautions to avoid activities, but not adjusted for | ||
- Walking (3.2 km) | 48 (60) | |||||||
- Cycling | 42 (53) | |||||||
- Golf | 19 (24) | |||||||
- Treadmill running | 16 (20) | |||||||
- Aerobics | 7 (8.8) | |||||||
- Tennis | 9 (11.3) | |||||||
- Stairclimbing machine | 10 (12.5) | |||||||
- Hiking | 13 (16.3) | |||||||
- Downhill skiing | 6 (7.5) | |||||||
Tegner | 1.3 (0–4) | 3.5 (1–6) | >97.5 % =2.5 % | |||||
Tegner >5 [meaning: regular participation in tennis, downhill skiing, cycling or strenuous (farm or construction) work) | 19 (24 %) | |||||||
No information concerning definition pre sports | ||||||||
Hopper and Leach (2008) UK [52] | Cross-sectional Follow-up: 21.6 mo (13–42) | Selected, ≤75 y
n: 76 pts 34 (45 %) M 42 (55 %) F Mean age: 62.1 y (35–75) Mean BMI: ? Co: ? OA: ? | No description | Low-impact sports (n = 76) Sports participation: |
n = 55 |
n = 36 | 64 %c
RTS% | Complications (pain 42.9 %, instability 25.7 %) Co-morbidities Both mentioned but not adjusted for |
- Swimming | 30 | 23 | 76.7 | |||||
- Bowls | 17 | 7 | 41.2 | |||||
- Golf | 17 | 5 | 29.4 | |||||
- Dancing | 16 | 11 | 68.8 | |||||
- Cycling | 15 | 7 | 46.7 | |||||
VAS satisfaction (about activities): | % | Time to RTS: 4.1 mo | ||||||
- Very satisfied | 56 | |||||||
- Satisfied | 25 | |||||||
- Fairly satisfied | 12 | |||||||
- Dissatisfied | 8 | |||||||
Sports frequency (N per week) | 3.0 | 2.0 | ∆ −1.0* | |||||
No information concerning definition pre sports | ||||||||
Huch et al. (2005) Germany [44] | Longitudinal, multicentre prospective trial Follow-up: 5 y | Selected, <75 y 389 pts 106 (27.3 %) M 283 (72.7 %) F Mean age: 66.3 y (SD 6.4) Mean BMI: ? (no mean, >75 % overweight) Co: ? OA: ? | No description | General (n = 389) | 94 % during life | 34 % | 36 % | List of reasons for reduction: Complications (pain 16.3 %) Co-morbidities (pain elsewhere 29.2 %) Precaution 41.7 % (pts advised against high-impact) Multivariable regression: Age: − Sex: M > F Pre sports level: + |
42 % at time of surgery (pre) | 81 % | |||||||
Sports participation: |
n = during life/pre | RTS% | ||||||
- Cycling | 55/27 | 32 | 58 | |||||
- Hiking | 38/2 | 28 | 73.7 | |||||
- Swimming | 45/27 | 36 | 80 | |||||
- Downhill skiing | 20/2 | 2 | 10 | |||||
- Gymnastics | 24/6 | 8 | 33.3 | |||||
- Cross-country skiing, jogging | 16/2 | 3 | 18.8 | |||||
- Tennis | 6/1 | 2 | 33.3 | |||||
- Dancing | 5/1 | 4 | 80 | |||||
Clear definition of pre sports | ||||||||
Keeney et al. (2014) USA [55] | Retrospective Follow-up (<55 y): 36 mo (12–118) Follow-up (65–75 y): 31 mo (12–110) | Non-selected 412 pts, 495 KAs, divided into 2 age groups: ≤55 y n = 150, 181 KAs 65–75 y n = 262, 181 KAs Mean age: ≤55: 49 y 65–75: 69.9 y Sex: ? Mean BMI: ≤55: 34 kg/m2
65–75: 32 kg/m2
OA: 79–95 % primary Co: ? | No description | UCLA: | RTS% | Age: no Sex: M > F BMI − Pre sports level only mentioned as possible confounder | ||
Group ≤55 y | 3.4 | 4.6 | 10 | |||||
Increase | 57 % | |||||||
Decrease | 14 % | |||||||
Group 65–75 y | 3.8 | 4.9 | 12 | |||||
Increase | 65 % | |||||||
Decrease | 14 % | |||||||
UCLA | >5 | |||||||
Group <55 y | 13 % | |||||||
Group 65–75 y | 23 % (Age ∆*) | |||||||
No information concerning definition pre sports | ||||||||
Lefevre et al. 2013 France [43] | Cross-sectional Follow-up: 7 ± 5.2 y | Selected, judokas (licensed at French Judo federation) with black belt >60 y 8 pts, 10 KAs Sex: ? Mean age: 72.8 y (range ± 5.2) Mean BMI: ? Co: ? OA: ? | No description | Sports participation | RTS% 63 Time to RTS: 5.2 (±2.2) mo | Pre sports level mentioned as possible confounder Surgeon advice: ‘many pts RTS, despite the surgeon’s recommendations to the contrary’ | ||
- Judo | 8 | 5b
| ||||||
Other sports | ||||||||
- Walking | Unknown | 7 | ||||||
- Swimming | Unknown | 7 | ||||||
- Bicycling | Unknown | 5 | ||||||
- Golf | Unknown | 1 | ||||||
Pre sports was defined as ‘during life’ | ||||||||
Münnich et al. (2003) Germany [45] | Prospective Follow-up: 7 y (2–18) Language: German | Non-selected 40 pts, 42 KAs 13 (32.5 %) M 27 (67.5 %) F Mean age: 68.8 y (50–83) Mean BMI: ? Co: ? OA: ? | Only comment that possible loading on prosthesis should be taken into account during rehabilitation | Sports participation: | 1 y/2 y | RTS% | Comment regarding importance of counselling by surgeon | |
- Walking | 28 | 32/30 | >100 | |||||
- Swimming | 16 | 12/7 | 75 | |||||
- Gymnastics | 11 | 23/19 | >100 | |||||
- Cycling | 16 | 15/15 | 93.8 | |||||
No information concerning definition pre sports | ||||||||
Walton et al. (2006) Australia [39] | Cross-sectional Follow-up: minimum 12 mo | Non-selected 120 pts, 142 KAs 59 (49.2 %) M 61 (50.8 %) F Mean age: 71.5 y (29–95) Mean BMI: ? Co: ? OA: 100 % primary | All pts had undergone standardised rehabilitation regimens | Sports participation | total/new | RTS%/time to RTS (wks) | Negative advice All pts were advised to cease high-impact activities such as jogging Health status mentioned as possible confounder | |
- Walking | 81 | 76/9 | 82.7/9.3 | |||||
- Swimming | 22 | 14/0 | 63.6/13.5 | |||||
- Golf | 15 | 6/0 | 40/12 | |||||
- Crown green bowls | 17 | 13/1 | 70.6/17.8 | |||||
- Cycling | 9 | 5/1 | 44.4/12.5 | |||||
- Hiking | 8 | 1/0 | 12.5/8 | |||||
- Fishing | 14 | 8/1 | 50/32 | |||||
- Tennis | 11 | 2/0 | 18.2/30 | |||||
- Gymnastics | 9 | 7/3 | 44.4/12.8 | |||||
>14 % =30 % <43 % no sports 13 % | ||||||||
Grimby score | 2.76 (1–6) | |||||||
No information concerning definition pre sports | ||||||||
Wylde et al. (2008) UK [53] | Cross-sectional Follow-up: ? (at least 1 y postoperative) | Non-selected 866 pts 355 (41 %) M 511 (59 %) F Mean age: 69.6 y (26–93) Mean BMI: ? Co: ? OA: ? | No description | General active in sports (n = 866) |
n = 253 Pre sports defined as ‘in 3 y before surgery’ |
n = 185 | RTS% 73 | Reasons not to RTS: - Pain - Functional problems - Medical advice - Fear of damaging joint - Lack of confidence Age: no Sex: M > F |
Study | Study design | Study population | Rehabilitation protocol | Outcome measures | Preoperative (pre) activity + definition | Postoperative (post) activity | RTS + time to RTS | Confounding factors |
---|---|---|---|---|---|---|---|---|
Fisher et al. (2006) UK [51] | Cross-sectional Follow-up: 18 mo (4–46) | Non-selected 66 pts 32 (48 %) M, 34 (52 %) F Mean age: 64 y (49–81) Mean BMI: ? Co: 4 pts restricted in PA due to medical problems OA: 100 % isolated medial compartment OA | No description | Regular sports participation (at least 1 × per month) |
n = 42 presympt
n = 15 <3 mo pre |
n = 39 | 93 % | Age Co-morbidities Complications (revision to TKA) Described as possible confounders and taken into account in results |
Sports participation | %RTS | |||||||
- Swimming | 13 | 12 | 92.3 | |||||
- Golf | 10 | 10 | 100 | |||||
- Dancing | 6 | 5 | 83.3 | |||||
- Bowls | 3 | 3 | 100 | |||||
- Cycling | 4 | 3 | 75 | |||||
- Hiking | 3 | 3 | 100 | |||||
- Jogging | 1 | 1 | 100 | |||||
- Gym | 1 | 1 | 100 | |||||
- Squash | 1 | 1 | 100 | |||||
UCLA | 4.2 (3–6) | 6.5 (3–9) | ∆ 2.3* | |||||
Clear definition of pre sports | ||||||||
Hopper and Leach (2008) UK [52] | Cross-sectional Follow-up: 22.3 mo (12–44) | Selected, ≤75 y 34 pts 20 (59 %) M 14 (41 %) F Mean age: 61.3 y (43–75) Mean BMI: ? Co: ? OA: ? | No description | Low impact sports (n = 34) |
n = 30 |
n = 29 | 96.7 %a
| Complications (pain 24,1 %, instability 0 %) Co-morbidities Both mentioned but not taken into account |
Sports participation | RTS% | |||||||
- Swimming | 12 | 9 | 75 | |||||
- Bowls | 14 | 11 | 78.6 | |||||
- Golf | 13 | 13 | 100 | |||||
- Dancing | 5 | 5 | 100 | |||||
- Cycling | 6 | 5 | 83.3 | |||||
VAS satisfaction (about activities) | % | |||||||
- Very satisfied | 81 | |||||||
- Satisfied | 7 | |||||||
- Fairly satisfied | 7 | |||||||
- Dissatisfied | 5 | |||||||
Sports frequency (N per week) | 3.2 | 3.4 | ∆ +0.2#
| |||||
No information concerning definition pre sports | Time to RTS: 3.6 mo | |||||||
Lo Presti et al. (2011) Italy [48] | Cross-sectional Follow-up: 24 mo (12–48) | Non-selected 53 pts 15 (28.3 %) M 38 (71.7 %) F Mean age: 59 y (46–66) Mean BMI: ? Co: ? OA: ? | Compulsory postoperative rehabilitation with restoration of muscular control was important for optimum function and return to activity (but no information about which pts followed such rehabilitation) | General performing a type of sports (n = 53) |
n = 46 |
n = 49 | >100 % | No information Probably low because very high % RTS |
Sports participation | ||||||||
- Cycling | 14 | |||||||
- Swimming | 12 | |||||||
- Dancing | 6 | |||||||
- Jogging | 5 | |||||||
- Tennis | 5 | |||||||
- Football | 5 | |||||||
- Mountain climbing | 5 | |||||||
- Skiing | 3 | |||||||
No information concerning definition pre sports | ||||||||
Naal et al. (2007) Switzerland [56] | Cross-sectional Follow-up: 18 mo (12–28) | Non-selected 83 pts 45 (54.2 %) M 38 (45.8 %) F Mean age: 65.5 y (47–83) Mean BMI: 28.3 kg/m2 (19.6–39.2) Co: ? OA: 86.7 % primary 13.3 % osteonecrosis | Pts were advised not to RTS before a sufficient muscular restoration of the quadriceps and hamstrings was reached | General active in ≥1 sport (n = 83) |
n = 77 |
n = 73b
| 94.8 % | Correlations: Age: no Sex: no BMI: − (weak) Pre sports: + |
Sports participation | RTS% | |||||||
- Hiking | 56 | 43 | 76.8* | |||||
- Cycling | 49 | 42 | 85.7 | |||||
- Downhill skiing | 48 | 18 | 37.5* | |||||
- Swimming | 42 | 34 | 81* | |||||
- Exercise walking | 33 | 28 | 84.9 | |||||
- Cross-country skiing | 21 | 7 | 33.3* | |||||
- Dancing | 21 | 6 | 28.6* | |||||
- Tennis | 21 | 3 | 14.5* | |||||
- Jogging | 18 | 2 | 11.1* | |||||
- Fitness | 12 | 16 | >100 | |||||
- Mountain climbing | 12 | 1 | 8.3* | |||||
- Soccer | 10 | 2 | 20* | |||||
- Aerobics | 6 | 5 | 83.3 | |||||
- Hand-/volley-/basketball | 6 | 3 | 50 | |||||
- Golf | 5 | 8 | >100 | |||||
- Gymnastics | 5 | 6 | >100 | |||||
- Riding | 4 | 1 | 25 | |||||
- Nordic walking | 3 | 7 | >100 | |||||
- Inline skating | 3 | 0 | 0 | |||||
- Fishing | 2 | 2 | 100 | |||||
- Ice hockey | 2 | 1 | 50 | |||||
- Snowboard | 2 | 0 | 0 | |||||
- Athletics | 2 | 0 | 0 | |||||
- Shooting | 1 | 1 | 100 | |||||
- Boxing | 1 | 0 | 0 | |||||
- Water skiing | 1 | 0 | 0 | |||||
- Home trainer | 0 | 3 | ? | |||||
- Ice skating | 0 | 1 | ? | |||||
Preoperative = before onset of restricting symptoms | Time to RTS (mo) <3: 46 % <6: 69 % >6: 31 % | |||||||
Pietschmann et al. (2013) Germany [46] | Cross-sectional Follow-up: 4.2 y (1–10 y) | Non-selected 131 pts 57 (44 %) M, 74 (56 %) F Mean age: 65.3 y (44–90) BMI, kg/m2 (mean): - Active 27.6 (20–56) - Inactive 29.3 (19–43) Co: ? OA: ? | Pts were encouraged to use crutches until completion of wound healing, but mobilise freely from the first postoperative day | General active in some type of sports |
n = 78 |
n = 63 | 80.8 % | Age: no BMI: − Complications and co-morbidities were equally distributed between active and inactive pts |
Sports participation | RTS% | |||||||
- Cycling | 45 | 44 | 97.8 | |||||
- Swimming | 17 | 14 | 82.4 | |||||
- Fitness | 9 | 10 | >100 | |||||
- Hiking | 13 | 13 | 100 | |||||
- Alpine climbing | 8 | 3 | 38.5 | |||||
- Golf | 3 | 3 | 100 | |||||
- Gymnastics | 14 | 12 | 85.7 | |||||
- Alpine skiing | 17 | 7 | 41.2 | |||||
- Cross-country skiing | 2 | 2 | 100 | |||||
- Soccer | 4 | 0 | 0 | |||||
- Tennis | 3 | 0 | 0 | |||||
- Table tennis | 1 | 1 | 100 | |||||
- (Nordic) walking | 4 | 10 | >100 | |||||
No information concerning definition pre sports | ||||||||
Walker et al. (2014) Germany [47] | Cross-sectional Follow-up: 3 y (2.0–4.3) | Non-selected 45 pts (lateral UKA) 19 (42 %) M 26 (58 %) F Mean age: 60.1 y (36–81) BMI, kg/m2 (mean): - Youngc 26 (21–42) - Oldc 28 (22–36) Co: ? OA: ? | No description | General active in ≥1 sports (n = 45) |
n = 42 pre = before onset of restrictive symptoms |
n = 41 | 97.6 % >67 % =24 % <9 % | Reasons for changing activities: - Precaution 56 % - Less Motivation 20 % - Instability 11 % - Pain 9 % - Overweight 4 % - Restricted range of motion 2 % - Lower back pain 2 % |
Sports participation | RTS% | |||||||
- Biking | 27 | 33 | > 100 | |||||
- Hiking | 22 | 18 | 81.8 | |||||
- Long walks | 22 | 20 | 91 | |||||
- Nordic walking | 11 | 11 | 100 | |||||
- Fitness | 9 | 17 | >100 | |||||
- Swimming | 9 | 15 | >100 | |||||
- Downhill skiing | 8 | 0 | 0 | |||||
- Jogging | 6 | 3 | 50* | |||||
- Soccer | 6 | 0 | 0 | |||||
- Tennis | 5 | 0 | 0* | |||||
- Aquarobics | 4 | 8 | >100* | |||||
- Cross-country skiing | 4 | 1 | 25 | |||||
- Aerobics | 4 | 9 | >100 | |||||
UCLA | 5.3 (±2.3) | 6.7 (±1.5) 2/3 > 7 | Time to RTS (months) <3: 56 % <6: 78 % >6: 22 % | |||||
Tegner | 2.9 (±1.6) | 3.5 (±0.8) | ||||||
Clear definition of pre sports | ||||||||
Walton et al. (2006) Australia [47] | Cross-sectional Follow-up: ≥12 mo | Non-selected 150 pts, 183 KAs 76 (51 %) M 74 (49 %) F Mean age: 71.5 y (36–92) Mean BMI: ? Co: ? OA: 100 % primary | All pts had undergone standardised rehabilitation regimens | Sports participation | Total/new | RTS%/time RTS (wks) | Negative advice All pts were advised to cease high-impact activities such as jogging Health status mentioned as possible confounder | |
- Walking | 77 | 88/18 | 90.9/7.9 | |||||
- Swimming | 23 | 27/5 | 65.6/9.4 | |||||
- Golf | 21 | 15/1 | 66.7/13 | |||||
- Crown green bowls | 20 | 19/3 | 80/24.6 | |||||
- Cycling | 19 | 20/4 | 84.2/11.8 | |||||
- Hiking | 18 | 10/1 | 50/18.7 | |||||
- Fishing | 11 | 10/1 | 81.8/16.2 | |||||
- Tennis | 8 | 3/0 | 37.5/10 | |||||
- Gymnastics | 7 | 8/5 | 42.9/11.7 | |||||
>13 % =54 % <19 % No sports 14 % | ||||||||
Grimby score | ? | 3.89 (1–6) | ||||||
No information concerning definition pre sports | ||||||||
Wylde et al. (2008) UK [53] | Cross-sectional Follow-up: ? (at least 1 y postoperative) | Non-selected 100 pts 48 (48 %) M 52 (52 %) F Mean age: 66.0 y (45–88) Mean BMI: ? Co: ? OA: ? | No description | General active in sports (n = 100) |
n = 36 Pre sports defined as ‘in 3 y before surgery’ |
n = 27 | 75 % | Reasons not to RTS - Pain - Functional problems - Medical advice - Fear of damaging joint - Lack of confidence Age: no Sex: M > F |
3.3 Methodological Quality
Study (n = 18) | Study participation | Study attrition (follow-up) | Prognostic factor | Outcome | Confounding factor | Analysis | Overall risk of biasa
|
---|---|---|---|---|---|---|---|
Argenson et al. (2008) [42] | Moderate | High | Low | Moderate | High | Moderate | High |
Bock et al. (2003) [41] | Low | Moderate | Low | Moderate | Low | Moderate | Moderate |
Bradbury et al. (1998) [50] | Moderate | Low | Low | Low | Low | Low | Low |
Chang et al. (2014) [49] | Moderate | Moderate | Moderate | Moderate | Moderate | Low | Moderate |
Chatterji et al. (2005) [40] | Moderate | Moderate | Moderate | Moderate | Moderate | Low | Moderate |
Diduch et al. (1997) [54] | Moderate | Low | Moderate | Moderate | Moderate | High | Moderate |
Fisher et al. (2006) [51] | Moderate | Moderate | Low | Moderate | Moderate | Moderate | Moderate |
Hopper and Leach (2008) [52] | Low | Moderate | Low | Moderate | Moderate | Moderate | Moderate |
Huch et al. (2005) [44] | Low | Moderate | Low | Low | Moderate | Low | Low |
Keeney et al. (2014) [55] | Moderate | High | Moderate | Moderate | High | Moderate | High |
Lefevre et al. (2013) [43] | Moderate | High | Moderate | Low | High | Moderate | High |
Lo Presti et al. (2011) [48] | High | Moderate | Low | High | High | High | High |
Münnich et al. (2003) [45] | Moderate | Moderate | Moderate | Moderate | High | Moderate | Moderate |
Naal et al. (2007) [56] | Moderate | Low | Low | Low | Low | Low | Low |
Pietschmann et al. (2013) [46] | Moderate | Moderate | Low | Moderate | Moderate | Moderate | Moderate |
Walker et al. (2014) [47] | Moderate | Low | Low | Moderate | Low | Moderate | Moderate |
Walton et al. (2006) [39] | Moderate | Moderate | Moderate | High | Moderate | High | High |
Wylde et al. (2008) [53] | Moderate | High | Moderate | Moderate | High | High | High |
3.4 Return to Sports (RTS)
3.5 Pooling of Data of Sports Participation, RTS and Time to RTS
3.5.1 Pre- and Post-Operative Sports Participation and RTS
Impact | Sports participation preoperative | Sports participation postoperative | Time to RTS | ||||||
---|---|---|---|---|---|---|---|---|---|
No. of sports | No. of patients | Average no. of sports/patient | No. of sports | No. of patients | Average no. of sports/patient | Time (weeks) | No. of patients | Average time (weeks) | |
TKA | (n = 7 studies) | (n = 10 studies) | (n = 4 studies) | ||||||
Low | 1265 | 1436 | 0.9 | 1262 | 1524 | 0.8 | 4682.5 | 370 | 13 |
Intermediate | 202 | 1436 | 0.1 | 132 | 1524 | 0.1 | 105.6 | 9 | 12 |
High | 107 | 1436 | 0.1 | 51 | 1524 | 0.03 | 232.5 | 9 | 26 |
Total | 1574 | 1436 | 1.1 | 1445 | 1524 | 1.0 | 5020.6 | 388 | 13 |
UKA | (n = 6 studies) | (n = 7 studies) | (n = 2 studies) | ||||||
Low | 612 | 509 | 1.2 | 629 | 562 | 1.1 | 2680.2 | 222 | 12 |
Intermediate | 237 | 509 | 0.5 | 155 | 562 | 0.6 | 280.6 | 18 | 16 |
High | 91 | 509 | 0.2 | 33 | 562 | 0.1 | 30 | 3 | 10 |
Total | 940 | 509 | 1.9 | 817 | 562 | 1.5 | 2990.8 | 243 | 12 |