title: Patient activity after TKA depends on patient-specific parameters.
abstract: BACKGROUND
  Most patients expect an improvement of walking ability and an increase in activity levels after TKA. Unfortunately, few studies report qualitative and quantitative activity improvements after TKA.
  
  
  OBJECTIVE
  The aims of this study were (1) to evaluate quantity and quality of physical activity before and after TKA with an accelerometer, and to compare activity level with that of an age-matched control group without lower-extremity disorders. (2) Improvement in measured steps per day after TKA and the ability to meet physical activity guidelines were evaluated. (3) The influence of patient-specific and implant parameters were assessed.
  
  
  METHODS
  An accelerometer was used to measure activity in 97 patients who were assessed before TKA and 1 year after TKA. The measurements included the total number of steps, moderate to vigorous activity defined as at least 100 steps per minute, and time spent lying, sitting/standing, or walking. We then calculated the proportion of patients who met the 10,000 steps per day guideline recommendation and determined factors that predicted failure to meet that goal. Thirty-nine age-matched control subjects without lower-extremity disorders were selected and underwent the same assessments using the accelerometer for comparison with patients 1 year after TKA.
  
  
  RESULTS
  Measured steps per day improved from a mean of 5278 (SD, 2999) preoperatively to 6473 (SD, 3654) postoperatively (effect size, 1.23; 95% CI, 1.10-1.35; p < 0.001). Moderate to vigorous steps per day improved from a mean of 1150 (SD, 982) to 1935 (SD, 1728; p < 0.001). Times spent in lying, sitting, or standing position or during walking did not change after TKA. For all measured parameters, activity of the patients after TKA was considerably less than that of the age-matched control subjects, who walked a mean of 13,375 (SD, 4614) steps per day (p < 0.001), performed a mean of 6562 (SD, 3401) vigorous steps per day (p < 0.001), and spent a mean of 2.9 hours (SD, 1.1) per day walking (p < 0.001). Only 16 patients (16.5%) met physical activity guidelines after TKA. BMI (p = 0.017), sex (p = 0.027), and comorbidities (American Society of Anesthesiologists Grade, p = 0.042) were independent factors associated with steps per day after TKA.
  
  
  CONCLUSIONS
  One year after TKA, patients had increased walking and moderate to vigorous steps. However, only 16.5% achieved the guideline recommendations for walking activity. BMI, sex, and comorbidities are patient factors that are associated with activity after TKA. Even with improvements in walking, activity level after TKA remains less than that seen for age-matched control subjects. Surgeons should be aware of this when counseling patients undergoing TKA.
  
  
  METHODS
  Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors: Cornelia
authors: C
authors: Lützner
authors: Stephan
authors: S
authors: Kirschner
authors: Jörg
authors: J
authors: Lützner
mesh_terms: D056044:Actigraphy; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001696:Biomechanical Phenomena; D015992:Body Mass Index; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking