TOTAL knee arthroplasty produced modest daily walking gains, with little improvement after the first postoperative year.
Total Knee Arthroplasty and Daily Walking Recovery
Total knee arthroplasty (TKA) improved real world walking in people with end stage knee osteoarthritis, but gains were modest and appeared to plateau after 1 year, according to a two-year longitudinal study comparing postoperative outcomes with healthy controls.
The study evaluated whether people undergoing TKA regained daily life walking comparable with age and sex matched healthy adults. Investigators used wearable inertial sensors to measure walking before surgery, then again at 1 and 2 years after TKA. Thirty-one individuals with unilateral knee osteoarthritis were enrolled and compared with 31 healthy participants without joint pain.
Wearable Sensors Capture Real World Gait
Daily life walking was recorded with three inertial movement units worn for 5 to 7 consecutive days. Sensors were placed on both feet and the lower back, allowing researchers to assess gait speed, maximum gait speed, stride time, stride length, turning velocity, maximum gait bout length, and strides per hour.
At 1 year after total knee arthroplasty, patients had a gait speed 0.10 m/s lower than healthy participants and a maximum gait speed 0.11 m/s lower. Maximum gait bout length was also reduced, suggesting that longer uninterrupted walking may remain limited even when average walking speed is close to that of healthy peers.
However, after adjustment for BMI, differences in gait speed, maximum gait speed, and maximum bout length were no longer statistically significant. Stride length became significantly shorter in the postoperative group after BMI adjustment.
Walking Gains Plateau After 1 Year
From baseline to 1 year after TKA, dominant gait speed increased by 0.10 m/s, while maximum gait speed increased by 0.07 m/s. Stride length improved, stride time decreased, and the number of strides per hour rose by 81 strides, indicating greater walking activity.
Still, only 12 of 27 participants exceeded the prespecified threshold of at least 0.10 m/s improvement in gait speed. One participant deteriorated beyond that threshold. No further improvements in walking metrics were observed between 1 and 2 years after surgery.
Patient reported outcomes improved more clearly. KOOS-PS scores improved by 16 points, pain at rest decreased by 3 points, and pain during activity decreased by 4 points at 1 year, with no additional improvement at 2 years.
The findings suggest that patients undergoing total knee arthroplasty may experience meaningful pain relief while achieving only modest improvements in daily walking performance. The authors emphasized the need for realistic expectations around mobility recovery after surgery.
Reference
Bruning FJ et al. Recovery of daily-life walking after total knee arthroplasty: A two-year longitudinal study and comparison with healthy controls. Osteoarthr Cartil Open. 2026;8(3):100835.
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