Arthroplasty of the hip and knee in athletes: risk, functional outcomes and return to sport| Lo Scalpello - Journal

Abstract

Introduction. The resumption of sports activity after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is a topic of growing interest, given the decrease in the mean age of patients undergoing these surgical procedures and the higher functional expectations of younger individuals. However, no univocal guidelines are available, and contrasting opinions persist regarding which sports are safe after prosthetic implantation.

Methods. A comparative narrative review of the evidence on return to sport (RTS) after THA and TKA was conducted. A literature search was performed on PubMed, analyzing studies published on the topic up to December 2024. Data were extracted on RTS rates, physical activity levels (UCLA and Tegner scores), mean recovery times, and the main predictive or limiting factors for RTS.

Results. The vast majority of patients return to at least one sport after THA or TKA. Patients with THA show slightly higher average RTS rates (up to ~80-90% for low-impact activities) and faster initial recovery compared with TKA patients (RTS ~70-80%). Physical activity levels (UCLA, Tegner scores) improve in a clinically significant way after surgery in both groups. Younger age, male sex, normal BMI, high preoperative activity level, and strong personal motivation emerge as factors favoring successful RTS, whereas fear, residual pain, and stiffness may limit it. Low-impact sports are generally well tolerated and may be resumed within 3-6 months after surgery; high-impact sports carry greater risks, but recent evidence indicates that regular physical activity does not increase complication or revision rates in the medium term, thanks to advances in materials and implant design.

Conclusions. RTS after hip or knee arthroplasty is a realistic and safe goal for most patients, contributing to improved quality of life. It is essential to personalize recommendations: prioritize low-impact activities and carefully evaluate return to more demanding sports, informing patients about potential risks. Further long-term studies are needed to better define recommendations, particularly for high-impact sports.