Total joint replacement: A multiple risk factor analysis of physical activity level 1–2 years postoperatively

Abstract

Background and purpose — The effect of total joint arthroplasty (TJA) on physical activity is not fully understood. We investigated the change in physical activity after TJA and patient factors associated with change.Patients and methods — Using a total joint replacement registry, primary total hip arthroplasty (THA) patients (n = 5,678) and knee arthroplasty (TKA) patients (n = 11,084) between January 1, 2010 and December 31, 2012 were identified. Median age at THA was 68 and median age at TKA was 67. Change in self-reported physical activity (minutes per week) from before TJA (within 1 year of surgery) to after TJA (1–2 years) was the outcome of interest. Patient demographics and comorbidities were evaluated as risk factors. Multiple linear regression was used.Results — Median physical activity before surgery was 50 min/week (IQR: 0–140) for THA patients and 58 (IQR: 3–143) for TKA patients. Median physical activity after surgery was 150 min/week (IQR: 60–280) for both THA patients and TKA patients. Following TJA, 50% of patients met CDC/WHO physical activity guideline criteria. Higher body mass index was associated with lower change in physical activity (THA: −7.1 min/week; TKA: −5.9 min/week). Females had lower change than males (THA: −11 min/week; TKA: −9.1 min/week). In TKA patients, renal failure was associated with lower change (−17 min/week), as were neurological disorders (−30 min/week).Interpretation — Self-reported minutes of physical activity increased from before to after TJA, but 50% of TJA patients did not meet recommended physical activity guideline criteria. Higher body mass index, female sex, and specific comorbidities were found to be associated with low change in physical activity. Patient education on the benefits of physical activity should concentrate on these subgroups of patients.

Does Activity-Based Rehabilitation With Goal Attainment Scaling Increase Physical Activity Among Younger Knee Arthroplasty Patients? Results From the Randomized Controlled ACTION Trial

“…Consequently, their preoperative PA levels may still have been relatively high and therefore a significant postoperative PA increase may have been unlikely [9]. Finally, high body mass index (BMI) is negatively associated with PA behavior in patients undergoing total joint arthroplasty [26,27]. In KA, Twiggs et al [28] found that obese patients reached a mean of 4819 steps 6 weeks postoperatively, compared to 7151 steps for overweight patients and 8022 steps for healthy weight patients.…”

“…Regarding possible solutions to further increase PA after KA, in order for more patients to meet health-enhancing PA guidelines, several authors have suggested a need for improved and individually tailored rehabilitation strategies [27,29]. The patienttailored GAS rehabilitation of our intervention group focused specifically on achieving activities that our individual patients wished to perform better.…”

Clinical outcome and physical activity measured with StepWatch 3™ Activity Monitor after minimally invasive total hip arthroplasty

“…Toogood et al also showed that BMI greater or less than 30 kg/m 2 had no influence on objective activity level [20]. In contrast to these results, self-reported physical activity at 1–2 years postoperatively after THA and TKA was lower depending on BMI, female sex, and specific comorbidities [22]. …”

The Role of Physical Activity and Rehabilitation Following Hip and Knee Arthroplasty in the Elderly

“…Types of activity and number of studies in which they were reported. Ergometer cycling 1 [7] 2 [7,8] Intensive physiotherapy 3 [8][9][10] Fast-track treatment 2 [11,12] 1 [11] Walking skill training 1 [13] Arm/upper body exercise 1 [14] Leisure activity (MET-hours/week, minutes/week) 2 [15,16] 4 [15][16][17][18] Winter sports (alpine skiing, cross-country skiing) 1 [19] 3 [18,20,21] Summer sports (trekking, hiking, biking, swimming) 1 [19] 3 [18,20,21] High-impact physical activity (baseball, gymnastics, hockey, basketball, martial arts, football, tennis) 2 [18,20] Low-impact physical activity (aquafit, golf, cycling, swimming) 2 [18,20] 3.…”