Aims: Total knee arthroplasty (TKA) reliably improves pain and function, however many patients increasingly expect return to recreational and sporting activities following surgery. This study compared preoperative activity expectations with 1-year postoperative activity levels and assessed the extent to which expectations were achieved.
Methods: This prospective observational cohort study included consecutive patients undergoing primary TKA for osteoarthritis between 2023 and 2024 at a single institution. Preoperatively, participants recorded both their current UCLA activity level and the level they expected to achieve at 1 year. The primary outcome was the proportion achieving or exceeding their preoperative expected UCLA level at 12 months. Secondary outcomes included change in UCLA score and satisfaction. Participants also completed baseline and 12-month patient-reported outcome measures including the Oxford Knee Score, HOOS-12, EQ-5D, satisfaction, and expectation. measures.
Results: A total of 663 patients were included (mean age 69 years, 54% female, median BMI 29). Only 45% achieved or exceeded their preoperative activity expectation at 1 year. While 57% expected to achieve a high activity level (UCLA >6), only 34% did so postoperatively. Preoperatively, 81% expected a higher postoperative activity level, with a median expected increase of 2 UCLA points. Median UCLA improved from 4 preoperatively to 6 at 12 months, with 59% achieving an improvement greater than the MCID and 50% improving by ≥2 points. Despite incomplete expectation fulfilment, 93% reported being satisfied or very satisfied at 12 months. Patients achieving or exceeding expectations were more likely to report being “very satisfied” (75% vs 61%, p=0.002). In multivariable logistic regression, greater expected improvement in UCLA score was independently associated with lower odds of achieving or exceeding expected activity level (OR 0.55, 95% CI 0.47–0.64, p<0.001), while male sex was associated with greater odds of expectation fulfilment (OR 1.73, 95% CI 1.22–2.46, p=0.002).
Conclusions: Most patients undergoing TKA expected substantial improvements in activity level, however fewer than half achieved or exceeded their preoperative activity expectations at 12 months. Higher expectations were associated with lower rates of expectation fulfilment despite greater actual postoperative improvement. Nevertheless, overall satisfaction remained high, highlighting the importance of expectation management and preoperative counselling regarding postoperative activity after TKA.
