Does delay in total knee arthroplasty impact postoperative performance? A case-based illustration

Optimal timing of TKA surgery is not clear. This report describes a patient's tested strength and function deficits before and after a surgical delay compared with a comparable cohort. TKA for OA was postponed due to non-health issues. Strength and functional performance were tested at 3 points preoperatively and 4 points postoperatively. Preoperative strength and functional performance precipitously declined during surgical delay. Quadriceps strength declined 47% from 6 months to one week pre-operatively, with the majority of this decline in the last 3 months. Pain levels peaked preoperatively, averaging 8.3/10. After 6 weeks of TKA, quadriceps recovered to immediate preoperative strength, but was 47% less than 6 months preoperatively. Function improved to 6 months preoperative levels by 6 weeks. Functional performance recovered to immediate preoperative levels by 6 months, while muscle strength (quadriceps and hamstrings) did not. This case describes a precipitous decline in strength and function during a 6-month surgical delay, with poorer recovery compared with a cohort without delay. While this case only describes a single individual, the results highlight the need for further research on optimal surgical timing for total knee arthroplasty, considering function, strength and pain levels, especially because strength recovery can have long-term implications.