Athletic activity after lower limb arthroplasty

Abstract

In this systematic review, our aim was to explore whether or not patients are able to return to athletic activity following lower limb joint replacement. We also investigated any evidence as to whether participation in athletic activity post-joint replacement increases complications and reduces implant survival. A PubMed, Embase and Sports Discus search was performed using the MeSH terms 'Sport', 'Athletic', 'Athlete', 'Physical', 'Activity', 'Arthroplasty', 'Total Hip Replacement', 'Hip Resurfacing', 'Total Knee Replacement', 'Unicompartmental Knee Replacement' and 'Unicondylar Knee Replacement'. From this search, duplications were excluded, the remaining abstracts were reviewed and any unrelated to the search terms were excluded. The remaining abstracts had their full papers reviewed. Following joint replacement, participation in sporting activity is common principally determined by pre-operative patient activity levels, BMI and patient age. The type of joint replaced is of less significance. Total time spent performing activity does not change but tends to be at a lower intensity. There is little evidence in the literature of an association between high activity levels and early implant failure.

Wear Testing of Moderate Activities of Daily Living Using In Vivo Measured Knee Joint Loading

“…Thus, higher rates of osteolysis and aseptic loosening should be expected with higher activity. In a recent systematic literature review, the relationship between revision rates, PE wear, and activity reported was analyzed [ 39 ]. The authors observed no increase in revision rates due to higher activity despite the fact that higher wear rates were verified for more active patients.…”

Return to sporting activity after Birmingham hip resurfacing arthroplasty

“…These include improved stability, low wearing bearing surfaces and improved proprioception 15 although it has been suggested that return to sporting activity post lower limb arthroplasty surgery is mainly determined by presurgical activity levels, BMI and age. 16 …”

Aerobic Physical Fitness and Recreational Sports Participation After Total Knee Arthroplasty

“…15,18,29,31,50,54,66,70 However, in patients who wish to resume recreational and occupational activities after TKA, the high loads placed on the knee joint may result in chronic effusions and muscle dysfunction. This is especially true in patients who return to high-impact occupations that may preclude participation in recreational activities due to a mechanical overload of the joint that produces pain and swelling.…”

“…Other reviews describe subjective expert opinion regarding the most appropriate activities after TKA. 22,29,54,66 However, the available evidence is low quality (level 3 or 4). One study focused solely on patients who resumed high-impact activities (tennis, aerobics, jogging, racquetball, squash), which represented only 4% of TKAs performed at 3 institutions over an 8-year period.…”

“…Former athletes have high expectations after TKA of resuming recreational activities, 29 and these expectations correlate strongly with postoperative patient satisfaction. 25,52,60 Unfortunately, many patients have residual quadriceps and hamstrings muscle weakness 1 to 3 years after TKA, 59 which strongly influences the ability to return to recreational and fitness training activities as well as patient satisfaction rates.…”