Preoperative Activity Linked to Lower Revision Risk but Higher Hardware Failure

Total knee arthroplasty remains the definitive intervention for end-stage knee osteoarthritis, yet recovery is frequently hindered by persistent deficits in proprioception (the neurological process of sensing joint position and movement) and muscle weakness that can persist for up to 3 years postoperatively [1, 2, 3]. While clinicians utilize prehabilitation (preoperative exercise programs designed to optimize physical capacity), a meta-analysis of 17 studies found that while exercise-based programs improve pain at 6 months and function at 12 months, the overall clinical significance of these interventions remains contested [4, 5]. Long-term quality of life is further modulated by patient-specific variables, particularly increased body mass index and comorbid depression, which are among the most consistent predictors of suboptimal outcomes [6, 7]. Recent data suggest that maintaining physical activity levels until the time of surgery is vital, as patients who cease sports participation in the year prior to the procedure are unlikely to reinitiate these activities after recovery [8]. This retrospective cohort analysis investigates how these baseline activity levels specifically correlate with the long-term risk of mechanical failure and the necessity for revision surgery.