The main indication for total knee replacement (arthroplasty) is for the relief of significant and disabling pain caused by severe arthritis that is not responding to conservative measures.
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Sports participation following Total Knee Arthroplasty:
A total knee arthroplasty is not necessarily a contraindication to sports activity and participation in sports does not appear to increase the complication rate; though common advice is not to participate in sport after a knee arthroplasty (link).
Effects on the Foot following a Total Knee Arthroplasty:
Typically, following a knee arthroplasty there are probably increased levels of activity and an altered weightbearing due to alignment improvements from the arthroplasty. This potentially has a number of impacts on the foot:
- Stress fractures can occur due to the repetitive load being greater than what the bone has had time to adapt to following the total knee athroplasty. Harato et al (2012) reported two cases of first metatarsal stress fracture following a total knee arthroplasty. Both cases had a significant knee varus deformity. Miki et al (2014) reported on five cases of calcaneal stress fracture following a total knee arthroplasty, indicating that there is a high risk for stress fractures in the postoperative rehabilitation period. Jeong et al (2016) reported on a calcaneal insufficiency fractures following an ipsilateral total knee arthroplasty. Yamamoto et al (2019) reported that 0.5% of TKA developed a calcaneal stress fracture. Kato et al (2021) reported 9 calcaneal insufficiency fractures in 1548 knee arthroplasties.
- Minimal differences in foot loading have been reported at 3 months following the replacement compared to preoperative (Voronov et al, 2011). However, this was a static measure and it is assumed that following the rehabilitation period after the arthroplasty there will be higher levels of activity.
- Levinger et al (2012) reported no changes in the Foot Posture Index before and after the athroplasty though there were significant differences in rearfoot kinematics.
- Thomas et al (2013) showed that 4 weeks of rehabilitation after a total knee replacement lead to improvements in navicular drop and relaxed calcaneal stance position.
- Hara et al (2014) reported an improvement in the hindfoot alignment in those with a valgus rearfoot.
- Okomato et al (2016) evaluated the hindfoot of 80 knees undergoing arthroplasty with the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and fund residual symptoms were common in those with an initial severe deformity
- Güven et al (2017) looked a the effects of different arthroplasty alignments on plantar foot loading and found differences based on knee alignment.
- Takenaka T et al (2016) reported that hindfoot alignment improved following the arthroplasty in the group with a valgus rearfoot, but not a varus hindfoot
- Tonogai et al (2o17) reported on changes to ankle alignment after a knee arthroplasty for knee varus.
- Cho et al (2017) showed an improvement in hindfoot valgus following a knee arthroplasty
- Mansur et al (2019) showed that a TKA promotes changes in the postoperative hindfoot axis, significantly in patients with knee valgus and hindfoot varus.
- Palanisami et al (2019): “following the correction of knee varus with TKA, hindfoot alignment and foot loading pattern are both restored in the majority of patients. TKA offers both static and dynamic correction as seen in the hindfoot and loading pattern, respectively.“
- Graef et al (2020): “higher degrees of leg axis correction in TKA were associated with increased postoperative ankle symptoms.“
- Diao et al (2021): “Our findings indicated that correction of HKA after TKA tend to promote adjustment in the hindfoot alignment toward re-balance of the whole lower limb weight-bearing axis“
- a systematic review by Butler et al (2021) on alignment of the hindfoot following total knee arthroplasty concluded that “demonstrated that the hindfoot may display compensatory changes in alignment following TKA in patients with knee OA. However, the marked heterogeneity between the included studies and poor QOE limits any meaningful cross sectional comparisons between studies.“
- Carmody et al (2022): “ Foot or ankle pain was reported in 45% before, 32% at 6 months and 36% at 12 months after TKA. Of those with preoperative foot pain, 42% at 6 months and 50% at 12 months reported no foot pain after TKA…“
- Rühling et al (2023): “A total of 69 patients (varus n = 45; valgus n = 24) underwent TKA and completed the postoperative follow-up visit. Of these, 16 patients (23.2%) reported the onset or progression of ankle symptoms.“
- Zhijun et al (2024) reported on an increased risk of acquired hallux valgus in patients eligible for knee replacement.
- Nazlıgül et al (2024) found that “The correction of the varus malalignment in the knee was shown to also improve the compensatory valgus in the foot and ankle over the mid-term, with a statistically significant improvement in the patients’ clinical ankle scores.“
- Wang et al (2024) found that kinematic alignment offered advantages over mechanical alignment in restoring a more physiologic plantar pressure distribution at two years postoperatively..
Effect of Foot Pain on Knee Arthroplasty Outcomes:
Gates et al (2016) reported that those with pre-operative foot pain are more likely to have poorer clinically important outcomes one year following the knee arthroplasty than those without foot pain.
External Links:
Stress fractures following knee replacement surgery (Podiatry Arena)
Foot loading following knee arthroplasty (Podiatry Arena)
Shoe Recommendation for Total Knee Replacement (Podiatry Arena)
Related Topics:
Lateral wedging for medial knee osteoarthritis | Osteoarthritis | Knee Osteoarthritis | Knee Osteoarthritis & Running
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