The Impact of Total Joint Arthroplasty on Long-Term Physical Activity: A Secondary Analysis of the Health and Retirement Study

Abstract

Objective Physical inactivity is the fourth leading cause of global mortality and is prevalent among people with lower extremity osteoarthritis. Lower extremity osteoarthritis is the most common arthritis type afflicting older adults, and total joint arthroplasty (TJA) performed to address the condition is Medicare’s largest annual expense. Despite TJA intervention to address the disabling effects of osteoarthritis, physical activity (PA) level remains stable 6 months after TJA; however, the effect of TJA on long-term PA $\Big(\ge$2 y) in a representative sample of older adults is unknown. The purpose of this study was to test the hypothesis that PA would remain stable in the long term. Methods In this longitudinal observational study, a probability-weighted difference-in-differences analysis was conducted to observe the predictive margins of nontraumatic hip or knee TJA on levels of vigorous and moderate PA after 2 years. A combined Health and Retirement Study data set of community-dwelling adults who were > 55 years old, had symptomatic osteoarthritis, and were in need of TJA between 2008 and 2018 (N = 4652) was used. Results TJA was not associated with vigorous PA ($\updelta$ = 2.37; SE = 5.23) or moderate PA ($\updelta$ = −2.84; SE = 7.76) after 2 years. Conclusion TJA was not associated with increased long-term PA in older adults with osteoarthritis. Impact Physical therapists should not assume that there will be a natural increase in PA after functional recovery from TJA procedures. Older adults with lower extremity osteoarthritis may benefit from PA screening and promotion practices in physical therapy services. Lay Summary Receiving a total joint replacement does not lead to increased physical activity levels 2 years after surgery.

Satisfactory adherence to the Dutch physical therapy guideline for patients with a total knee arthroplasty. A survey study involving 103 specialised physical therapists

“…In our study, 63% of therapists were fully adherent with the clinical practice guideline, and partial adherence could mostly be attributed to not using aerobic exercise training. This is a potential opportunity for improvement for those patients to become more physically active, with corresponding substantial health benefits, because decreased activity levels preoperatively will not automatically increase after the procedure (LeDoux et al, 2022;Paxton et al, 2015). In fact, the study of Groen et al (2012) showed that 42% of patients with a TKA (n = 830) were not active enough 1 year postoperatively and beyond to meet the recommended physical activity level that promotes health (Groen et al, 2012;Health (Wainwright et al, 2020) also ensures that PT in the outpatient practice starts at an earlier postoperative stage.…”

“…In our study, 63% of therapists were fully adherent with the clinical practice guideline, and partial adherence could mostly be attributed to not using aerobic exercise training. This is a potential opportunity for improvement for those patients to become more physically active, with corresponding substantial health benefits, because decreased activity levels preoperatively will not automatically increase after the procedure (LeDoux et al., 2022; Paxton et al., 2015). In fact, the study of Groen et al.…”

Patients with High Pre-Operative Physical Activity Take Longer to Return to Baseline

“…While evidence has suggested that physical activity (PA) in patients with OA may improve both joint pain and function, as well as other comorbid conditions and quality of life [4], the associated discomfort may limit these patients from achieving recommended levels of PA. Authors have reported that the majority of patients with OA do not meet guideline recommendations for daily activity [5,6], performing less PA than age-matched subjects without OA [7]. In addition, several reports have suggested that these patients spend the majority of their time in sedentary behaviors [8][9][10], which has been shown to significantly impact the risk of morbidity and mortality in adult populations [11].…”

Adding Behaviour-Change Counselling to an Exercise Program for Adults Preparing for Hip and Knee Arthroplasty Improves Psychological and Physical Wellness: Focus Group Reflections

“…Exercise is prescribed for symptomatic improvement once surgery is recommended for end-stage OA; however, this has shown equivocal results on function when implemented either before surgery or following surgery [6]. While people describe improvements in a range of patient's reported outcomes after hip and knee arthroplasty, improvements in physical activity levels are not seen [7], and physical activity interventions delivered after surgery are not effective [8].…”