Key Predictors for Returning to Running After Total Knee Arthroplasty: A Multifactorial Analysis

Background Total knee arthroplasty (TKA) can improve function in knee osteoarthritis. However, the advisability of resuming high-impact activities, such as running, after surgery remains debated, with limited evidence available on the factors that influence patients' ability to return to such activities. This study aims to investigate the subjective experiences and self-reported outcomes of skilled runners who have resumed running after TKA, and to identify factors that may influence the likelihood of successfully returning to running. Methods This is an exploratory analysis on whether resuming high-impact activities should be advised postoperatively. An online survey was conducted among 79 members of a "TKR Runners" Facebook group. Participants self-reported pre- and post-operative running habits, abilities, experiences, demographic, surgical, and health information. Associations were analyzed using descriptive statistics and inferential tests in SPSS. Descriptive variables were analyzed and inferential tests were used to assess factors associated with running postoperatively. Results 79.2% of respondents reported running post-TKA. Shorter pre-TKA running cessation (1–2 years; p = 0.041), longer post-TKA duration (median 1.50 vs. 0.46 years for non-runners; p < 0.001), higher weekly mileage (35–40 miles; p = 0.044), and longer event participation (10k, half marathon; p = 0.049, p = 0.044) were associated with post-TKA running. Running with little to no pain at the time of the survey (avg mean = 1.9 years) correlated with greater time since surgery and event participation (both p < 0.001). Pre-TKA depression (p < 0.001) and lower perceived ability to run again (p < 0.001) were associated with incomplete recovery, defined as an inability to run due to persistent pain. Conclusion Many individuals are able to resume running after TKA, with several modifiable pre- and post-operative factors influencing this outcome. These findings can ameliorate patient-provider discussions regarding the potential for returning to running following TKA. This study provides insights into factors influencing resuming running after TKA, which can inform clinical recommendations and decision-making for active patients considering the procedure.