TKR/Community and Home Participation after Total Knee Replacement

The TKR study has concluded. Visit our presentations page for Dr. Maxwell’s publications related to this study

Specific Aims

  1. To explore home and community participation among persons with a total knee replacement at least 2 years.
  2. To determine the risk factors associated with limited participation (e.g., body mass index, knee pain severity, muscle weakness, function, etc.) among persons with a total knee replacement at least 2 years earlier.
  3. To explore peoples’ perceptions of mobility-related factors that influence their participation at least 2 years status post TKR among persons with restricted participation.


Since knee replacement is increasing dramatically, the problems encountered frequently by these patients will affect large numbers of Americans, the majority with osteoarthritis and rheumatoid arthritis of the knee. Given the critical importance of keeping people involved and active in their communities for their quality of life and health status, it is imperative to understand peoples’ participation levels and factors associated with participation status post knee replacement.

Jessica Maxwell photoDescription

Principal Investigator: Dr. Jessica Maxwell
Co-Principal Investigator: Dr. David Felson

Total knee joint replacement is frequently performed when severe knee osteoarthritis (OA) significantly impairs physical functioning. The frequency of total knee replacement (TKR) nearly doubled from 1998 to 2005, and TKR procedures are expected to increase dramatically as the prevalence of knee OA increases.  The outcomes of TKR, though, are not clear. After TKR, approximately 80% of persons are satisfied, have less pain, and have better function (e.g., walking, stair climbing). After one year post TKR, function begins to decline with progressive decline noted for at least 5 years. Twenty percent of persons do not have improvements in pain or function at least initially.

The role TKR has on participation outcomes (e.g., involvement in life situations) is not known. The limited research shows performance of daily activities improves within the first year post surgery and then stabilizes through the second post-operative year. Participation status longer than 2 years post TKR has not been examined. Given the high frequency of TKR procedures, it is of vital importance that we understand the full extent of the outcomes likely following TKR so that consumers and clinicians can make informed choices as to when to undergo this invasive and potentially life-changing procedure.

The goal of this study is to gain a better understanding of home and community participation among persons 2 or more years following total knee replacement. To accomplish our objectives we will first examine participation restriction data from 2 prior studies, Multicenter Osteoarthritis (MOST) Study and the Osteoarthritis Initiative (OAI), and second we will explore people’s perceptions regarding the factors that make participation difficult.