Return to Sports After Primary Total Knee Arthroplasty: A Prospective Cohort Study of 1782 Patients

Background: Total knee arthroplasty (TKA) provides pain relief and functional improvement for end-stage knee osteoarthritis patients. As TKA use increases in younger patients, return to sports (RTS) has become a key outcome measure. While RTS rates after TKA are generally high, they vary significantly across studies due to differences in study design, patient populations, and RTS definitions. Purpose: To determine RTS rates, evaluate return to preoperative sport levels, quantify time to RTS, and identify factors affecting RTS after TKA. Study Design: Cohort study; Level of evidence, 2. Methods: We analyzed 21,466 primary TKAs performed between 2016 and 2022. Of these, 1782 patients (8.3%) were athletes at baseline, with 1464 (82.2%) completing 1-year follow-up. We recorded demographic characteristics, comorbidities, baseline and 1-year RTS status, time to RTS, athlete type, and patient-reported outcomes. Analysis included descriptive statistics, Cox regression for time to RTS, and logistic regression for RTS-associated factors. Results: Of 1464 patients, 782 (53.4%) achieved RTS, while 676 (46.6%) did not; both contact and noncontact sports were included. Among those who returned, 62% resumed their previous sport at the same level, 34.5% at a reduced intensity, and 3.4% switched to a different sport. The median RTS time was 12 weeks, with 90% returning within 27 weeks. Medicaid patients had a delayed RTS compared with those with commercial insurance (hazard ratio HR, 0.51). Overweight patients returned sooner than normal-weight patients (HR, 1.41). Female patients (odds ratio OR, 0.76) and Black patients (OR, 2.34) had lower RTS odds, while recreational (OR, 0.06) and competitive athletes (OR, 0.10) had higher RTS odds versus those not participating in athletic activities. Conclusion: Over half of athletes returned to sports within 1 year of TKA, most within 27 weeks. RTS rates varied by preoperative competitive level, sex, race, body mass index, and comorbidity burden. These findings can guide patient expectations and shared decision-making regarding post-TKA sports participation. Future research should focus on improving RTS rates in high-risk groups, standardizing RTS criteria, and stratifying outcomes by sport type and impact level to enable more individualized patient recommendations.