Maintaining or Increasing Physical Activity Is Essential for Managing Cardiovascular and Cerebrovascular Risks After Total Knee Arthroplasty: A Nationwide Cohort Study.

Background: We sought to evaluate the incidence of cardiovascular and cerebrovascular diseases in patients undergoing total knee arthroplasty (TKA) and the impact of perioperative physical activity levels on these risks.

Methods: This nationwide cohort study used data from the National Health Insurance Service of the Republic of Korea. Patients who underwent a pair of health examinations at 2-year or 4-year intervals and did not have a diagnosis of cardiovascular or cerebrovascular disease at the first examination were included. The study population was divided into those who underwent TKA and those who did not between the 2 examinations. Physical activity was defined on the basis of the frequency of moderate-to-high-intensity activities and was categorized into inactive or active 1 to 2, 3 to 4, and ≥5 times weekly. Cox proportional hazards models were used to evaluate the association between physical activity changes and disease incidence over a 5-year follow-up.

Results: Compared with controls who did not undergo TKA, patients who underwent TKA exhibited higher incidences of cardiovascular diseases (19.3% compared with 17.1%) and cerebrovascular diseases (25.7% compared with 23.9%). These incidences were associated with perioperative physical activity levels. Higher physical activity levels after TKA were associated with lower risks of both diseases. Specifically, engaging in physical activity ≥5 times per week was linked to lower cardiovascular risk (hazard ratio [HR], 0.918; p < 0.001) and cerebrovascular risk (HR, 0.890; p < 0.001). Previously inactive patients who began activity showed a reduction in the risks of both diseases, whereas previously active patients who became inactive had a significantly increased cerebrovascular risk.

Conclusions: Patients who underwent TKA demonstrated higher incidences of cardiovascular and cerebrovascular diseases compared with controls over a 5-year follow-up. Our findings underscore the importance of initiating regular physical activity after surgery, particularly among previously inactive patients. Conversely, the increased cerebrovascular events among patients who ceased activity emphasize the critical need to maintain activity levels after surgery. Therefore, maintaining or initiating physical activity may be a core component of optimizing long-term outcomes after TKA.

Level Of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.