Quality, but not quantity of physical activity is associated with metal ion concentrations in unilateral hip resurfacing

Abstract

Little is known about the influence of physical activity (PA) on metal ion concentrations in subjects with metal‐on‐metal hip arthroplasty. Implant wear is thought to be a function of use and thus of patient activity levels. It is hypothesized that daily habitual PA of patients with hip resurfacing arthroplasty (HRA) is associated with metal ion concentrations. Therefore a study was conducted in patients with a unilateral HRA at 10‐years follow‐up. Blood metal ion concentrations were determined. An acceleration‐based activity monitor was used to measure PA in daily life. The cohort consisted of 12 males (75%) and 4 females (25%) with a median age at surgery of 55.5 ± 9.7 years [43.0–67.9] and a median follow‐up of 9.9 ± 1.0 years [9.1–10.9]. The median cobalt and chromium ion concentrations were 25 ± 13 and 38 ± 28 nmol/L. A significant association between sit‐stand transfers and high‐intensity peaks with cobalt ion concentrations were found. Regarding PA and metal ion concentrations as a proxy of wear in HRA, specific activities like transfers or qualitative aspects of activity behavior like intensity, seem to matter more than the quantity of low‐intensity activities like walking or cycling. This suggests that patients may safely engage in such activities to achieve important general health benefits and quality of life.

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

“…Number of steps taken was assessed in 11 articles in 10 unique groups. All articles used objective measurement methods, two in combination with a questionnaire [ 43 , 62 , 63 , 75 , 87 , 114 , 117 , 123 , 128 , 132 , 133 ]. Results showed six articles reporting an average 5000–7000 steps/day and four articles (three studies) reporting means between 4000 and 5000 steps/day.…”

“…Number of steps was reported in two articles measuring the same group using an accelerometer [ 132 , 133 ], with a daily steps median of 5546 and range 2274 to 9966. Time spent in PA was reported by the same studies as number of steps [ 132 , 133 ]. Active time was 10.8% of the accelerometer wear time.…”

“…Also, those studies using one-item questionnaires commonly reported that subjects sometimes or regularly participated in moderate activities like swimming, housework, and shopping after THA, TKA, and UKA, which implies participation in activities of daily living. Persons after HRA indicated regular participation in active events, yet the only studies performing objective measures involving a comparable study group found a relatively inactive population with a mean of only 5546 steps/day [ 132 , 133 ]. As this study included only 16 persons, results should be interpreted with caution.…”

Patients with hip resurfacing arthroplasty are not physically more active than those with a stemmed total hip

“…The number of subjects was rather low. The main cause for this was the initially strict inclusion criteria for the initial HRA study (Jelsma et al 2020 ). Another limitation was that no objective information, e.g., PA monitoring data, were available for the preoperative setting of the subjects.…”

“…We compared 2 groups, one having received unilateral HRA and a matched group having received unilateral stemmed THA with a small diameter metal or ceramic femoral head (28 mm) on conventional polyethylene with osteoarthritis as indication for surgery. The HRA group with a median follow-up of 10 (9–11) years was initially recruited for another study, the methods of which are described in detail elsewhere (Jelsma et al 2020 ). The stemmed THA group was matched by sex, age at surgery, follow-up since surgery, and BMI.…”