Amount and type of physical activity and sports from one year forward after hip or knee arthroplasty—A systematic review

Abstract

Introduction After rehabilitation following total hip or knee arthroplasty (THA/TKA), patients are advised to participate in physical activity (PA) and sports. However, profound insight into whether people adopt a physically active lifestyle is lacking. Aim is to gain insight into the performed amount and type of PA (including sports) and time spent sedentarily by persons after THA/TKA. Methods A systematic review (PROSPERO: CRD42020178556). Pubmed, Cinahl, EMBASE and PsycInfo were systematically searched for articles reporting on amount of PA, and on the kind of activities performed between January 1995-January 2021. Quality of the articles was assessed with the adapted tool from Borghouts et al. Results The search retrieved 5029 articles, leading to inclusion of 125 articles reporting data of 123 groups; 53 articles reported on subjects post-THA, 16 on post-hip-resurfacing arthroplasty, 40 on post-TKA, 15 on post-unicompartimental knee arthroplasty and 12 on a mix of arthroplasty types. With respect to quality assessment, 14 articles (11%) met three or fewer criteria, 29 (24%) met four, 32 (26%) met five, 42 (34%) met six, and 6 (5%) met seven out of the eight criteria. PA levels were comparable for THA and TKA, showing a low to moderately active population. Time spent was mostly of low intensity. Roughly 50% of -subjects met health-enhancing PA guidelines. They spent the largest part of their day sedentarily. Sports participation was relatively high (rates above 70%). Most participation was in low-impact sports at a recreational level. Roughly speaking, participants were engaged in sports 3 hours/week, consisting of about three 1-hour sessions. Conclusion Activity levels seem to be low; less than half of them seemed to perform the advised amount of PA following health-enhancing guidelines Sports participation levels were high. However, many articles were unclear about the definition of sports participation, which could have led to overestimation.

Patients with total hip arthroplasty were more physically active 9.6 years after surgery: a case-control study of 429 hip arthroplasty cases and 29,272 participants from a population-based health study

“…Our study reports higher levels of leisure-time physical activity in the THA group than previously described [7]. This may be explained by selection.…”

“…After THA, patients are more likely to return to low-intensity activities such as walking and cycling than high-intensity activities such as running and tennis [6]. Physical activity levels in the years following THA seem to be low, with less than half of subjects meeting health-enhancing guidelines [7]. Few studies report on long-term levels of physical activity after THA compared with a control population [8].…”

Patients with High Pre-Operative Physical Activity Take Longer to Return to Baseline

“…Authors have reported that the majority of patients with OA do not meet guideline recommendations for daily activity [5,6], performing less PA than age-matched subjects without OA [7]. In addition, several reports have suggested that these patients spend the majority of their time in sedentary behaviors [8][9][10], which has been shown to significantly impact the risk of morbidity and mortality in adult populations [11].…”

Translation, Cross-Cultural Adaptation and Validation of the Chinese Version of the High Activity Arthroplasty Score

“…[6][7][8] Postoperative dissatisfaction is often attributed to patients' unmet expectations, particularly regarding their desire to engage in low-impact exercise and maintain participation in intermediate-to high-impact activities. [9][10][11] In response to patients' heightened expectations of physical activity after TKA, there is a growing need to determine the appropriate level of physical activity and acceptable types of activities for these patients. 12,13 Traditional physicianprovided outcomes alone may not sufficiently address these questions, highlighting the importance of incorporating patient-reported outcome measures (PROMs).…”