Does physical activity change following hip and knee replacement? Matched case-control study evaluating Physical Activity Scale for the Elderly data from the Osteoarthritis Initiative

Abstract

Objectives: To determine whether physical activity measured using the Physical Activity Scale for the Elderly (PASE), changes during the initial 24 months post-total hip (THR) or knee replacement (TKR), and how this compares to a matched non-arthroplasty cohort.Design: Case-controlled study analysis of a prospectively collected dataset.Setting: USA community-based.Participants: 116 people post-THR, 105 people post-TKR compared to 663 people who had not undergone THR or TKR, or had hip or knee osteoarthritis. Cohorts were age-, gender-and BMImatched. Main outcome measures:Physical activity assessed using the 12-item PASE at 12 and 24 months postoperatively.Results: There was no significant difference in total PASE score between pre-operative to 12 months (mean: 136 vs. 135 points; p=0.86) or 24 months following THR (mean: 136 vs 132 points; p=0.95).Whilst there was no significant difference in total PASE score from pre-operative to 12 months post-TKR (126 vs. 121 points; p=0.93), by 24 months people following TKR reported significantly greater physical activity (126 vs. 142 points; p=0.04). There was no statistically significant difference in physical activity between the normative matched and THR (p≥0.14) or TKR (p≥0.06) cohorts at 12 or 24 months post-joint replacement.Conclusions: Physical activity is not appreciably different to pre-operative levels at 12 or 24 months post-THR, but was greater at 24 months following TKR. Health promotion strategies are needed to encourage greater physical activity participation following joint replacement, and particularly targeting those who undergo THR. 4 CONTRIBUTION OF THE PAPER• There is no significant change in physical activity from before to 24 months after THR.• Physical activity following TKR increases from pre-operatively levels, but only after 24 months post-operatively.• Physiotherapists should consider strategies to better support people, both those following THR and those without joint replacement, to be more physically active.

Feasibility and Preliminary Outcomes of a Physical Therapist–Administered Physical Activity Intervention After Total Knee Replacement

“…A study by Losina et al demonstrated that financial incentives combined with telephone health coaching and a Fitbit led to a clinically meaningful increase in steps/day within the first 6 months after TKR . Furthermore, our finding that PA did not change from 6 to 12 months after surgery is consistent with the literature . In a meta‐analysis, Hammett et al observed no change in PA at 6 months after TKR, with only a small change in PA at 12 months .…”

Participation in Regular Physical Activity After Total Knee or Hip Arthroplasty for Osteoarthritis: Prevalence, Associated Factors, and Type

“…Due to an inability to collect both objectively measured and patient‐reported volume data from a national cohort, we did not seek to determine the proportion of respondents achieving the recommended levels of weekly physical activity pre‐ and postsurgery. Based on previous studies demonstrating that very few patients achieve the levels recommended , we feel that many are possibly not achieving the recommended levels and, thus, future behavior change interventions will need to focus on both type and quantity of activity, not just participation, if the health of arthroplasty recipients is to be improved.…”

“…Prospective longitudinal studies , cross‐sectional studies , and several systematic reviews have attempted to quantify or infer changes in activity volume (frequency, intensity, duration) after TKA or THA. Currently, due to limitations in measuring physical activity, differing study designs, and inadequate control of potentially confounding patient covariates, to what extent physical activity increases postsurgery, if at all, is unclear .…”

“…Currently, due to limitations in measuring physical activity, differing study designs, and inadequate control of potentially confounding patient covariates, to what extent physical activity increases postsurgery, if at all, is unclear . In fact, many researchers have suggested that if activity volume increases, it still falls short of the recommended weekly levels stipulated in exercise prescription guidelines . Regarding physical activity participation rates, the literature varies with respect to the population prevalence of participation postsurgery and whether rates increase after surgery compared to presurgery levels.…”

“…Estimates for participation postsurgery range from 21% to 83% , with some studies indicating an increase and others a decrease compared to presurgery. Variation between studies may reflect methodologic or population differences such as sample size or age differences, how physical activity is defined (e.g., competitive sport versus regular recreational activity), the presurgical benchmark (e.g., the year prior to surgery or several years before ), and differences in reporting change (e.g., change in activity among those reporting that they are active presurgery versus the whole cohort ).…”