Does Activity Level After Primary Total Hip Arthroplasty Affect Aseptic Survival?

Abstract

Background The purpose of this study is to evaluate survivorship and outcomes of high-activity patients compared to low-activity patients after total hip arthroplasty. Methods A retrospective review identified 2002 patients (2532 hip) that underwent a primary total hip arthroplasty with vitamin E–infused highly crosslinked polyethylene liner. Patients were divided into 2 groups based on their University of California Los Angeles (UCLA) activity level: low activity (LA) (UCLA ≤5) and high activity (HA) (UCLA ≥6). Outcomes included Harris Hip Score, UCLA activity score, and reoperations. A multivariate nominal regression analysis was performed to evaluate the significance of postoperative activity level on survivorship. Results The mean follow-up duration was 4.5 years (range, 0.3 to 9.9 years). HA group had significantly higher improvements in Harris Hip Score (HHS) ( P < .001) and UCLA activity score ( P < .001). Aseptic revisions were performed in 2.1% of the LA group and in 0.4% hips of the HA group ( P < .001). After controlling for age, gender, preoperative pain, HHS, and body mass index, a higher postoperative activity level remained a significant factor for improved aseptic survivorship with an odds ratio of 4.9 (95% confidence interval, 1.1 to 21.2, P = .03). The all-cause 5-year survivorship was 99% for the HA group and 96% to for the LA group ( P < .001). The aseptic 5-year survivorship was 99.6% for the HA group and 98% for the LA group ( P < .001). Conclusions This study found that a higher activity level after primary THA was not deleterious to survivorship at short to midterm follow-up with modern implants.

Activity Following Total Hip Arthroplasty: Which Patients Are Active, and Is Being Active Safe?

“…Yet after adjusting the groups for age, BMI, CCI, ASA, and preoperative activity, the low-activity group still showed inferior revision-free survival compared to the moderate-as well as the high-activity group. Similar findings were reported by Crawford et al in 2021, who found that a higher activity level (defined as UCLA > 6) was a significant factor for improved implant survival after THA [18].…”

“…The risk of aseptic loosening due to implant wear is frequently cited as an argument against high activity [5,6,19,37]. However, the current findings suggest that, despite the biomechanical proof of increased wear due to increased forces, actual clinical findings may not justify general advice against high physical activity [17,18]. The risk associated with being highly active in general and participating in certain desired sports specifically should be evaluated and discussed together with the patient on an individual basis rather than imposing generalized restrictions.…”

“…Furthermore, habitual jogging was not associated with adverse effects [15][16][17]. Comparing highly active versus less active patients, an evaluation of more than 2500 THA patients with a follow up of 4.5 years reported that high activity improved implant survival, even after adjusting for potential confounding factors such age, gender, or body mass index (BMI) [18].…”

“…The current literature mainly focusses on either the influence of certain specific sports or on single complications such as dislocations [15][16][17]21]. Studies investigating overall revision rates mostly compare active versus inactive patients or younger versus older patients [18,22].…”

Fretting Wear and Corrosion-Related Risk Factors in Total Hip Replacement: A Literature Review on Implant Retrieval Studies and National Joint Replacement Registry Reports

“…Fretting and the increased cyclic loading of the interfaces result in creating an environment conducive to corrosion. This finding raises a significant concern for the performance of modular implants in active patients in the long term [56][57][58][59][60][61].…”