Does Physical Activity Increase After Total Hip or Knee Arthroplasty for Osteoarthritis? A Systematic Review

Abstract

® T t STUDY DESIGN: Systematic review. T t BACKGROUND: Despite improvements inself-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is unclear whether changes in objectively measured physical activity (PA) occur after surgery. T t OBJECTIVE:To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. T t METHODS:Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer-and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. T t RESULTS:Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. T t CONCLUSION:The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative strategies to instill behavioral change are required to narrow the gap between patient-perceived functional improvement and the actual amount of PA undertaken after THA and TKA. Registered with PROSPE-RO (registration number CRD42014010155). T t LEVEL OF EVIDENCE:Therapy, level 2a.

Early Unpleasant Postoperative Symptoms for Patients Undergoing Primary Hip versus Primary Knee Replacement: Patient Perception

“…In relation to age, the present study represented that more than half of the patients' ages ranged from 50 to 60 years with mean age 47.3. This result is in agreement with Arnold, Walters, and Ferrar (2016) who demonstrated that majority of their participant's age ranged from 58.2 to 69 years. The aging population has no doubt contributed to the worldwide increase in THR and TKR numbers as age is the strongest predictor of the development and progression of osteoarthritis [30] .…”

“…This result is in agreement with Arnold, Walters, and Ferrar (2016) who demonstrated that majority of their participant's age ranged from 58.2 to 69 years. The aging population has no doubt contributed to the worldwide increase in THR and TKR numbers as age is the strongest predictor of the development and progression of osteoarthritis [30] . On the other hand, this result is in disagreement with WDahl, Robertsson, and Lidgren (2010) who presented that THR and TKR is more frequent with younger age [31] .…”

“…Total hip and total knee replacement are promising management strategies which are forecasted to increase dramatically during the next 20 yr [25,26] . However, most major orthopedic surgery like THR and TKR involves large injured tissues and requires much time under general or regional anesthesia.…”

Patients who underwent total hip or knee arthroplasty are more physically active than the general Dutch population

“…A recent systematic review on physical activity after THA or TKA measured with accelerometers showed that the post-operative PA levels were lower in the arthroplasty groups as compared to healthy control participants [31]. The differences in outcome could be because our sample of the general population might not be totally healthy and be less active than selected healthy persons.…”

Impact of a tailored activity counselling intervention during inpatient rehabilitation after knee and hip arthroplasty – an explorative RCT

“…The health risks for OA patients regarding reduced physical activity (PA), (such as a higher prevalence of type II diabetes), as well as the positive aspects of being physically active, (such as less prevalence of metabolic syndrome), were recently summarized in a vivid review by Paxton and colleagues [7]. However, several studies have demonstrated that PA after knee or hip arthroplasty is low, and that, although clinical outcomes and physical functioning appears to be good, patients do not meet current activity guidelines [8–11]. While a wide range in the amount of PA after knee and hip arthroplasty has been reported in previous research in Germany, in each study PA among patients was observed to be less compared to that of healthy peers [12–14].…”