Medium Activity Prevents Periprosthetic Bone Mass Loss in the Medial Metaphyseal Region of the Tibia after Posterior‐Stabilized TKA : A 5‐Year Follow‐up Study of 110 Knees

Objective The bone mass around the prosthesis plays an important role in the stability of the prosthesis. This study aimed to assess the effect of postoperative activity on bone mineral density (BMD) in the proximal tibia 5 years after total knee arthroplasty (TKA). To provide a scientific guidance for postoperative functional exercise. Methods 110 patients underwent unilateral primary TKA were divided into three groups based on the University of California Los Angeles (UCLA) activity scale: low activity group (LA group, UCLA = 4, 5); medium activity group (MA group, UCLA = 6, 7); and high activity group (HA group, UCLA = 8, 9). The primary observation was a comparison of the BMD and BMD change percentage (Delta BMD (%)) in the periprosthetic tibia among the LA, MA and HA groups at 1 year, 3 years and 5 years. The secondary observations were radiographic evaluation (prosthetic stability, periprosthetic fractures, aseptic loosening and periprosthetic joint infection) and clinical evaluation (Knee Society Score (KSS), visual analogue score scores and range of motion (ROM)). A one-way ANOVA was used to compare the clinical scores and BMD among the three groups. Results The BMD of medial region decreased by 10.80%, 12.64%, 13.61% at 1, 3, and 5 years respectively; these were 5.72%, 6.26%, 7.83% in lateral region and 1.42%, 1.78%, 3.28% in diaphyseal region. For medial metaphyseal region, the BMD of the MA group was significantly greater than that of the LA and HA groups at 1 and 3 years (108.9 +/- 5.2 vs. 106.1 +/- 6.69 vs. 105.4 +/- 5.2 and 108.5 +/- 6.0 vs. 101.2 +/- 6.76 vs. 103.0 +/- 6.8, P < 0.01 and P < 0.001), and the BMD changes (Delta BMD (%)) in the MA group were significantly smaller than those in the LA and HA groups (8.75 +/- 5.36 vs. 11.92 +/- 5.49 vs. 12.70 +/- 5.21 and 9.11 +/- 5.11 vs. 16.04 +/- 4.79 vs. 14.82 +/- 4.26, P < 0.01 and P < 0.001). Regarding secondary observations, all of the prostheses were assessed as stable, without periprosthetic fractures, aseptic loosening and periprosthetic joint infection. Regarding KSS scores, there was no significant difference among the three groups. However, the VAS and ROM of the HA group were better than those of the MA and LA groups (1.65 +/- 0.79 vs. 2.63 +/- 0.77 vs. 3.00 +/- 1.17, p < 0.001, and 111.90 +/- 9.17 vs. 110.20 +/- 6.78 vs. 102.90 +/- 8.48, P < 0.001). Conclusion Medium activity prevented periprosthetic bone loss in the medial metaphyseal region of the tibia after posterior-stabilized TKA, and moderate-intensity exercise is recommended for patients after TKA to reduce periprosthetic bone loss.