How fast can younger total knee arthroplasty (TKA) patients get back to work or play?
That’s the question a team of Cleveland Clinic and Case Western Reserve researchers tried to answer with a systematic review of the literature. The team was hoping to quantify to determine rates, timelines, and prognostic factors which can determine how fast young TKA patients return to work and / or return to sports. Their work, “Return to Sports and Return to Work After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis,” was published in The Journal of Bone and Joint Surgery on July 27, 2023.
The Cleveland Clinic and Case Western Reserve University School of Medicine research team reviewed 44 studies with 9,113 patients who’d been treated with a primary TKA. Indeed, while different aspects of TKA patient return to work or play have been reviewed before, according to co-author Nicolas Piuzzi, M.D., “This is the most up-to-date and comprehensive study to look at both return to work and return to sports in patients undergoing TKA.”
Dr. Piuzzi, who is co-director of the Musculoskeletal Research Center at Cleveland Clinic, added, “The increasing utilization of TKAs, particularly among younger patients, and the significance of resuming activities like employment and sports after the procedure, have sparked our interest in this subject. Recognizing the growing importance of return to work and return to sports after TKA for patient satisfaction prompted us to delve into better understanding the implications and outcomes of TKAs in these contexts.”
Considering all studies, the team found the return-to-work rate to be 65% (rates varied from 10% to 98%). The mean time to return to work was 12.9 weeks. The investigators determined that increased age was associated with lower return-to-work rates.
The overall return-to-sports rate was 82% (ranging from 36% to 100%). The mean time to return to sports was 20.1 weeks.
Breaking things down further, the researchers categorized the sports into high-intensity (hiking, running, and tennis) and low-intensity (golf, walking, swimming, and cycling). They found that return-to-sports ranged from 43% to 98%, with a pooled proportion of 76% for low-intensity sports, and from 0% to 55% for high-intensity sports, with a pooled proportion of 35%.
Specifically, walking and swimming had the highest pooled incidences with 81% and 71%, respectively, whereas running and tennis had the lowest incidences—14% and 20%.
“The comprehensive analysis of factors affecting return-to-work and return-to-sports underlines the complexity of this topic,” said Dr. Piuzzi to OTW. “This awareness is crucial for managing patient expectations and providing tailored counseling, considering the intricate variables influencing post-TKA return to activity and expected timelines.”
Dr. Piuzzi also addressed the issue of patient expectations and told OTW, “We place emphasis on the standardized and consistent integration of this topic [return to work or play] into discussions with all patients scheduled for elective TKA. Our suggestion is rooted in the understanding that a proactive approach to addressing return-to-work and return-to-sports aspirations can lead to enhanced patient satisfaction. This practice would ensure that patients are well-informed, allowing them to actively participate in decisions and planning regarding their recovery journey.”
