Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

High Level of Residual Symptoms in Young Patients After Total Knee Arthroplasty

Javad Parvizi MD, FRCS, Ryan M. Nunley MD, Keith R. Berend MD, Adolph V. Lombardi MD, Erin L. Ruh MS, John C. Clohisy MD, William G. Hamilton MD, Craig J. Della Valle MD, Robert L. Barrack MD



TKA is among the fastest growing interventions in medicine, with procedure incidence increasing the most in younger patients. Global knee scores have a ceiling effect and do not capture the presence of difficulty or dissatisfaction with specific activities important to patients.


We quantified the degree of residual symptoms and specific functional deficits in young patients who had undergone TKA.


In a national multicenter study, we quantified the degree of residual symptoms and specific functional deficits in 661 young patients (mean age, 54 years; range, 19–60 years; 61% female) at 1 to 4 years after primary TKA. To eliminate observer bias, satisfaction and function data were collected by an independent, third-party survey center with expertise in administering medical outcomes questionnaires for federal agencies.


Overall, 89% of patients were satisfied with their ability to perform normal daily living activities, and 91% were satisfied with their pain relief. After TKA, 66% of patients indicated their knees felt normal, 33% reported some degree of pain, 41% reported stiffness, 33% reported grinding/other noises, 33% reported swelling/tightness, 38% reported difficulty getting in and out of a car, 31% reported difficulty getting in and out of a chair, and 54% reported difficulty with stairs. After recovery, 47% reported complete absence of a limp and 50% had participated in their most preferred sport or recreational activity in the past 30 days.


When interviewed by an independent third party, about 1/3 of young patients reported residual symptoms and limitations after modern TKA. We recommend informing patients considering surgery about the high likelihood of residual symptoms and limitations after contemporary TKA, even when performed by experienced surgeons in high-volume centers, and taking specific steps to set patients’ expectations to a level that is likely to be met by the procedure as it now is performed.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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