Can Chinese patients restore normal knee function 1 year after total knee arthroplasty?

Objective To develop a culturally adapted assessment tool for evaluating one-year postoperative knee function in Chinese patients after total knee arthroplasty (TKA), and to establish foundations for localized evaluation protocols and early postoperative interventions. Methods This cross-sectional study systematically reviewed knee function assessment items for post-TKA patients. Based on expert and patient focus group discussions, a set of evaluation items was established, followed by designing a self-administered questionnaire assessing importance, frequency, and difficulty. From February to December 2024, TKA patients at 1 year post-surgery and age-matched healthy controls were recruited at Honghui Hospital, Xi’an, China. High-frequency activities were identified and compared between groups. Results A total of 39 culturally relevant knee function items were developed through expert and patient consensus. The study included 713 TKA patients and 675 age-matched healthy controls, and 14 high-frequency activities were identified based on importance ratings. No significant functional differences were observed between TKA patients and controls in individuals under 65 years. In the 65–75-year group, only females showed decreased performance in picking up items from the ground ( p < 0.001). Among participants older than 75 years, males showed significant deficits in putting on and taking off shoes and socks ( p = 0.008), squatting ( p < 0.001), picking up items from the ground ( p = 0.009), and carrying heavy objects with one hand ( p < 0.001), while females demonstrated reduced ability in bathing and wiping ( p < 0.001), picking up items from the ground ( p < 0.001), and squatting ( p = 0.048). Conclusion Most patients regain daily function 1 year after TKA, but limitations persisted in older patients. The 14 culturally relevant activities identified provide a practical basis for a localized assessment. Future work will involve longitudinal validation and clinical integration to support individualized postoperative rehabilitation.