Knee surgery scores points with athletes and older patients with arthritis

Older patients with advanced knee osteoarthritis (OA) who have undergone total knee replacement (TKR) surgery experience significantly improved dynamic balance in addition to pain relief and improved function, according to a study presented at the recent American Academy of Orthopaedic Surgeons (AAOS) annual meeting in New Orleans. In another study, researchers found that patients may participate in high-impact sports activities after total knee arthroplasty (TKA) without increasing the risk of early implant failure-and may even achieve better clinical scores.

The TKR researchers conducted their study to determine whether the procedure has any effects on balance measures in correlation with functional balance and quality of life in older patients because falls are the leading cause of injury in this age-group. Their findings included the following:
•Significant improvement in dynamic balance was seen 1 year after surgery.
•There was significant progress in balance-determined motor tests.
•A strong statistical correlation was seen between balance and Oxford Knee Score functional questionnaire and Short Form–36 quality-of-life questionnaire results.

One year after surgery, the correlation between patients’ improved balance and ability to walk and perform activities of daily living (ADLs) was stronger than that between their reduced pain and ability to walk and perform ADLs. The authors noted that improved balance is a significant quality-of-life change in older patients, especially those who have knee problems, such as OA.

In the TKA study, researchers evaluated the outcomes of 218 patients aged 18 to 90 years who underwent primary knee arthroplasty and reported performing heavy manual labor or participating in a nonrecommended sports activity after surgery, compared with 317 control-group patients who followed recommended activity guidelines. Clinical and radiological results were measured using Knee Society scores. The authors observed better clinical scores in the group of patients who participated in activities discouraged by the Knee Society-those that cause high stress loads on the implant and may increase the risk of early failure, such as high-impact aerobics, football, soccer, baseball, basketball, jogging, and power lifting-than in patients in the control group.

Other findings included the following:
•No significant radiological differences and no significant differences in implant durability were seen between the groups.
•The control group had a 20% higher revision rate for mechanical failure than the sport group.

The authors noted that with recent studies showing 1 in 6 patients with TKRs participating in nonrecommended activities, their results offer reassurance to patients who choose to return to an active lifestyle after surgery. They added that optimizing outcomes for patients who have TKRs is important because the number of procedures performed in the United States-550,161 in 2007-continues to increase.

For more information on these and other topics discussed at the AAOS annual meeting, visit the AAOS Web site at http://www.aaos.org. Or, contact the organization at American Academy of Orthopaedic Surgeons, 6300 North River Road, Rosemont, IL 60018-4262; telephone: (847) 823-7186; fax (847) 823-8125.