High rate of return to low-impact physical activity or sports after total and unicompartmental knee arthroplasty: A systematic review with meta-analysis

Rodrigo Braz; Eluana Gomes; Cristina Valente; Hamada Ahmed; Mohamed Moursy; Diego Delgado; Mikel Sanchez; Renato Andrade; João Espregueira-Mendes

doi:10.1002/ksa.70267

High rate of return to low-impact physical activity or sports after total and unicompartmental knee arthroplasty: A systematic review with meta-analysis

Knee Surg Sports Traumatol Arthrosc. 2026 Jan 13. doi: 10.1002/ksa.70267. Online ahead of print.

Authors

Rodrigo Braz¹, Eluana Gomes^{2

3}, Cristina Valente^{2

3}, Hamada Ahmed⁴, Mohamed Moursy⁴, Diego Delgado⁵, Mikel Sanchez⁶, Renato Andrade^{2

3

7}, João Espregueira-Mendes^{1

2

3

8

9}

Affiliations

¹ School of Medicine, University of Minho, Braga, Portugal.
² Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal.
³ Dom Henrique Research Centre, Porto, Portugal.
⁴ Physical Medicine & Rehabilitation, Medical Affairs Department, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia.
⁵ Advanced Biological Therapy Unit, MiKS Hospital, Vitoria-Gasteiz, Spain.
⁶ Arthroscopic Surgery Unit, MiKS Hospital, Vitoria-Gasteiz, Spain.
⁷ Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto, Portugal.
⁸ ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal.
⁹ 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Portugal.

PMID: 41527885
DOI: 10.1002/ksa.70267

Abstract

Purpose: Rates and time to return to physical activity (PA) or sports following knee arthroplasty remain poorly explored in the current literature. This systematic review with meta-analysis aimed to synthesise the return to PA or sports after knee arthroplasty, comparing between total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA).

Methods: PubMed, Web of Science and Embase databases were searched up to December 2025 to identify studies reporting the return to PA or sports following knee arthroplasty. A meta-analysis was performed to evaluate the outcomes and to compare results between TKA and UKA. The rate of return to PA or sports was reported as pooled proportions, while comparisons between TKA and UKA for dichotomous outcomes were expressed as odds ratios (ORs) with corresponding 95% confidence intervals (CIs).

Results: Forty-five studies were included, encompassing 14,498 knees from 13,716 individuals (65.5 ± 3.5 years) who underwent knee arthroplasty. The overall rate of return to PA or sports was high (85.2%, 95% CI: 76.8%-92.1%), within a median of 4.1 months. The likelyhood of returning to PA or sports was significantly lower after TKA than UKA (OR = 0.31, 95% CI: 0.12-0.82). Certainty of evidence across all outcomes was rated as very low. Patients displayed a postoperative increase in PA scores was observed, and reported satisfaction rates ranged from 61% to 100%. Participation in high-impact sports declined, with the most commonly cited reason being precautionary behaviour.

Conclusions: Most patients can expect to resume PA or sports within a short timeframe after knee arthroplasty, particularly to low-impact activities. Those with UKA displayed higher likelihood to return to PA or sports. Participation in high-impact sports often declines, largely due to psychological factors that may limit participation in PA beyond the actual physical capabilities, underscoring the need for better patient counselling.

Level of evidence: Level IV.

Keywords: arthroplasty; knee; physical activity; sports.

Publication types

Review