Understanding the impact of physical activity level and sports participation on implant integrity and failure in patients following unicompartmental and total knee arthroplasty: A scoping review

Objective

Recommendations discouraging high levels of physical activity and sports following unicompartmental (UKA) and total knee arthroplasty (TKA) have been questioned in recent years. This scoping review aimed to summarize the literature examining the impact of physical activity level and sports participation on implant integrity and failure in patients following UKA and TKA.

Methods

Five databases (Medline, Embase, SCOPUS, CINAHL, ProQuest) were searched up to April 17, 2024. Retrospective, prospective and cross-sectional studies were included if they assessed the impact of physical activity level and/or sports participation (exposure variables) on implant integrity and/or failure (outcome variables) at ≥1 year following UKA or TKA. Two authors independently conducted abstract/full text reviews and data charting. Extracted data were summarized using descriptive analysis.

Results

Of 2014 potential records, 20 studies (UKA: n ​= ​6 studies, 2387 patients/TKA: n ​= ​14 studies, 7114 patients) met inclusion criteria. Following both UKA & TKA, most patients regularly participated in light to moderate physical activities and lower impact sports (e.g. walking, cycling, golf). No studies reported a deleterious effect of physical activity level or sports participation on implant integrity or failure post UKA (mean follow-up: 3.3–10.3 years). Three studies reported an association between greater levels of physical activity with increased risk of implant failure post TKA (mean follow-up: 1–11.4 years).

Conclusions

No studies demonstrated an association between greater levels of physical activity and sports participation with increased implant wear or failure post UKA, whereas results were mixed following TKA. There is a need for large, prospective cohort studies with long-term follow-up.