Survivorship, return to sport, and biokinetic risk factors in total knee arthroplasty for young patients: current concepts

Résumé fourni par la source

Total knee arthroplasty (TKA) is a successful treatment for knee osteoarthritis, with up to 92% implant survival at 20 years. This success has led to its increased use in younger patients (under 55), who benefit from early pain relief and improved quality of life, but face higher revision risks due to prolonged implant exposure, higher activity levels, and mechanical loading over time. Biokinetic stresses from sports and other high-demand activities are a critical yet often overlooked factor, as decades of repetitive loading may influence long-term outcomes. This narrative review summarizes recent evidence from English-language consensus statements and systematic reviews on implant survivorship, revision risk factors, sports participation, and biomechanical considerations in younger TKA patients. Implant survivorship rates in younger patients are 52.1% to 65.3% after 40 years. Higher revision rates are linked to varus alignment, increased posterior tibial slope, thinner polyethylene inserts, and fewer comorbidities. Low-impact sports like cycling and swimming are encouraged post-TKA, while high-impact sports should be approached cautiously. Biokinetic risk factors, such as altered gait patterns (e.g., stiff-knee gait, dynamic valgus, and increased flexion moment), warrant both preoperative and postoperative motion analysis and may be particularly important in younger patients, given their longer duration of implant use. In summary, young patients undergoing TKA can generally expect excellent implant survivorship, functional outcomes, and satisfaction. Specific risk factors for revision in this population require careful attention. Although current evidence does not link sports participation to increased revision rates or implant wear in the short to mid-term, the combination of long-term implant use and increased mechanical loading during activities represents an important frontier and ongoing challenge in the field. LEVEL OF EVIDENCE: Not Applicable [Current Concepts Review].

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