Recommendations for return to sports after total hip arthroplasty are becoming less restrictive as implants improve

Abstract

Introduction Total hip arthroplasty (THA) surgeries are expected to exponentially increase in the upcoming years, likely because of the overall broader indication of THAs. With these developments, an increasing number of younger (< 50 years) and active patients will receive surgical interventions, and expectations for an active lifestyle will accordingly increase. In addition, surgeons now have a growing array of techniques and implant materials to choose from. Despite these developments, evidence to provide the best standard-of-care to patients with high expectations for return to sports (RTS) is scarce and urgently needed. What recommendations do arthroplasty surgeons currently make to patients with high return to sports expectations, what factors may influence their recommendations and what surgical techniques and implant specifications are considered favorable in the treatment of patients with a more active lifestyle? This study was conducted to analyze the current recommendations, patient assessment, and patient counseling after THA to identify trends and relevant factors for surgical decision-making in patients with high-RTS expectations. Material and methods We designed a questionnaire comprising five general items and 19 specific items that included 46 sub-items for hip arthroplasty and conducted a survey among 300 German surgeons specialized in arthroplasty at the German Arthroplasty Society (AE) to assess expert opinions, recommendations, surgical decision-making, and patient counseling for patients with high expectations for RTS after THA. Results The majority of surgeons (81.9%) were in favor of RTS after THA. Risks associated with sports after THA were considered minimal (1%), with periprosthetic fractures ranking highest, followed by hip dislocation and polyethylene wear. Some surgical decision-making was influenced by high-RTS expectations in regard to implant fixation, stem type, femoral head diameter, and bearing-surface tribology. We observed an increasingly liberal counseling of patients for high-impact sports. Conclusion With the improvement of implants and surgical techniques, surgeons are more willing to encourage patients to adopt a more active lifestyle. However, the true long-term limitations need further investigation in future studies. Level of evidence 5 Expert opinions.

In vivo loading on the hip joint in patients with total hip replacement performing gymnastics and aerobics exercises

“…In a survey among German arthroplasty surgeons the majority of surgeons recommended activities such as pilates and dancing without restrictions, while gymnastics was only recommended with adequate training or even not at all. The authors' survey questionnaire did not specify the time, type or intensity of training required 15 . However, so far, it is unknown how the hip joint is loaded effective in vivo during gymnastics and aerobic exercises.…”

“…Despite the increased patient expectations there are still no conclusive evidence-based guidelines from the professional orthopedic associations on which basis sport activities can be recommended 12 , 15 , 19 .…”

Abductor Muscle Strength Deficit in Patients After Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

“…Patient-reported outcomes after THA are excellent and hence the magnitude of the reported strength deficit probably has little effect on patient satisfaction. However, the incidence of THA is expected to increase in the next decades [45], older patients maintain an active lifestyle, and surgeons increasingly encourage patients receiving a THA to do physical activities [46]. The population receiving a THA is expected to have higher expectations regarding daily, physical and recreational activities.…”

In vivo analysis of hip joint loading on Nordic walking novices

“…Osteoarthritis of the hip joint is among the most common orthopaedic conditions and often results in the necessaity of a total hip arthroplasty (THA) for affected patients [ 8 , 9 ]. The average age of patients receiving THA surgery has been steadily decreasing during the last years and especially for younger patients, the ability to resume sports is one of the key aims after surgery [ 10 – 12 ]. This has lead to an increase in physical activity of the average patient after joint replacement and thereby also to higher functional demands of the THA [ 13 , 14 ].…”

“…This has lead to an increase in physical activity of the average patient after joint replacement and thereby also to higher functional demands of the THA [ 13 , 14 ]. However, there are no evidence based guidelines regarding the return to sports after such surgery, and recommendations regarding the adequate amount and type of physical activity diverge [ 10 , 15 ]. While excessive sport might lead to accelerated wear, loosening or even fractures, a certain level of physical activity certainly improves quality of life, reduces diverse health risks (e.g.…”