Does total knee replacement restore normal knee function?

Despite the advanced age of many patients having total knee arthroplasty, previous attempts to quantify patient function postoperatively have not allowed for normal deterioration of musculoskeletal function that occurs with aging. We determined the effects of aging on knee function, thereby providing a realistic level of normal, healthy knee function for patients and surgeons after total knee arthroplasties. A self-administered, validated knee function questionnaire consisting of 55 scaled multiple choice questions was used in this study. Responses were collected from 243 patients at least 1 year after they had total knee arthroplasties, and from 257 individuals (age- and gender-matched) who had no previous history of knee disorders. Many of these latter subjects reported that they could do most of the activities cited in the questionnaire without symptoms attributable to their knees. However, knee symptoms were experienced more frequently during activities that placed greater loads on the extremity. There was no difference in the knee function of men and women, and both groups had continuous deterioration in knee function with increasing age. There were large differences in the functional capacity to do activities involving the knee between the group of patients who had total knee arthroplasties and the age- and gender-matched patients with no previous knee disorders. Overall, 52% of the patients who had total knee arthroplasties reported some degree of limitation in doing functional activities, versus 22% of subjects with no previous knee disorders. Two groups of activities were identified: activities in which the patients and control subjects had essentially similar knee function (swimming, golfing, and stationary biking), and activities in which the function scores of the control group exceeded the scores of the patients who had total knee arthroplasties (kneeling, squatting, moving laterally, turning and cutting, carrying loads, stretching, leg strengthening, tennis, dancing, gardening, and sexual activity). Our data show that many of the limitations reported by patients after total knee arthroplasties are shared by individuals with no previous knee disorders. However, only approximately 40% of the functional deficit present after a total knee arthroplasty seems to be attributable to the normal physiologic effects of aging. Patients who had total knee replacements still experienced substantial functional impairment compared with their age- and gender-matched peers, especially when doing biomechanically demanding activities. This suggests that significant improvements in the procedure and prosthetic designs are needed to restore normal knee function after a total knee arthroplasty.