THA and sports

1. TOTAL HIP ARTHROPLASTY AND RETURN TO
SPORT ACTIVITY (RTS)
• Literature is inconclusive
• Not high quality studies
• Patients are able to return to sporting activity following JR
• The intensity of activity to which patients return tends to be less than
before surgery
• At mid-term at least, there was no increase in implant failure in active
patient

2. A total of 37 studies
Methodological quality was high in 11 studies
RTS was reported in 14 studies.
Mean RTS was 104% to the pre-surgery level and 82% to
the pre-symptomatic sports level
Time to RTS varied from 16 to 28 weeks
Mean RTS varied from 43 to 144%, the latter indicating that
more patients participated in sports activities
postoperatively than preoperatively

3. For the two high-quality studies, Huch et al. and Schmidutz
et al, RTS was 100% and 98%, respectively, relative to the
pre-surgery level
No studies with a low risk of bias reported time to RTS.
Many confounding factors in these studies
Both high-quality studies used the pre-surgery level and not
the pre-symptomatic level as a reference and consequently
found very high RTS percentages (98 and 144%)

4. Physical activity does not change in the first
3 months post-surgery.
The results of follow-ups > 3 months but <
12 months are contradictory
The results of follow-ups > 12 months
provide weak evidence of increased PA
Assessment of changes in PA due to TJA is
challenged by the wide variability in
demographics, methods used to assess PA,
and different pathways of care used across
studies.

5. 17 investigated knees alone
20 studies investigated hips alone
4 studies investigated both hip and knee joints.
8 studies gave descriptions of joint replacement
outcomes for specific sports (four for golf , two for
tennis, one for running, one for skiing)
22 studies discussed a number of general
activities; these were a mixture of high-impact,
such as tennis and jogging, or low impact, such as
walking, swimming and cycling.
12 alluded to activity in general but made no
mention of specific sports

6. The rate of return to sport varied widely
between 54% and 98% across the papers.
Higher levels of activity were associated with
lower ages, male gender, lower BMI,
participation in sport pre-operatively, and
absence of other joint pain.
There was no difference in performance
between THR and HR patients, nor between
knee and hip replacements in five studies

7. 1st Consensus for RTS from American Hip and
Knee Surgeons

8. Racquetball/squash, baseball/softball, and snow- boarding were activities with a recommendation of not allowed
singles tennis and martial arts were listed as undecided
it was agreed that swimming, golf and cycling were permissible, while contact sports and jogging were not

9. the majority have shown that patients are more inclined to return to low- rather than high-impact activities,
there has been no clear consensus on whether this is a rational position for patients or their surgeons.
33% of AAHKS members allowed their patients to return to sports within the first 3 months postoperatively
compared with 24% from the HS
71% of the HS members recommended a return to sports at 3 to 6 months, whereas only 58.4% of AAHKS
members recommended this time interval for return to sporting activities ( P = .001)
91% would allow their patients to return to sporting activity six months post-surgery, with one third allowing
activity at three months

10. 2nd Consensus from Danish surgeons

11. Danish Consensus
• A pronounced variation between the departments was observed
• compared to the latest published US recommendations in 2007, the present Danish
recommendations are significantly more liberal
• Athletic activities are now allowed by 87 % of the Danish arthroplasty departments.
• Of these 55 % allow for high-impact activities after THA compared to 21 % in US in 2007.
• Recommendations for TKA patients are less liberal. Only 38 % of the departments allow
for high-impact activities after TKA compared to the 55 % after THA.

12. 54 patients (108 hips)
prospectively
Midterm follow-up 5.2 years.
mean UCLA activity score was 4.7
An increasing number of patients were active
in sports at follow-up compared with before surgery
(76.5% vs 60.8%, respectively); 2 patients (3.9%)
stopped participating in sports on a regular basis, and
10 (19.6%) commenced with sports after surgery.
The most popular activities before surgery were
cycling (31.4%), hiking (29.4%), swimming (21.6%),
and fitness/weight training (15.7%).
At follow-up, most patients were engaged in cycling
(35.3%) and fitness/weight training (33.3%), followed
by swimming (25.5%) and hiking (19.6%).
The duration (hours per week) and frequency (times
per week) of sporting activities remained stable.
The mean VAS pain level during sports was 1.3 (range,
0.0-7.0).
No revision surgery had to be performed.
Postoperatively, few patients were engaged in high-
impact sports

13. We surveyed 1310 patients (aged <75 years) who
underwent uncemented ceramic-on-ceramic THA
and collected levels of motivation and participation
for 22 different sports as well as patient-reported
outcome measure scores. A total of 1042 patients
(1206 hips) returned questionnaires; the mean age
at index surgery was 60.6 ± 8.8 years.
RESULTS:
At least 51% of patients participated regularly or
frequently in at least 1 light sport, 73% in at least 1
moderate sport, and 20% in at least 1 strenuous
sport. Sports participation was strongly correlated
with motivation (r = 0.97, P < .001) but not with
level of discomfort (r = 0.22, P = .292). Participation
in strenuous sports was significantly associated with
age, body mass index, and sex. There were
significant differences among patients who
practiced various categories of sports as determined
using the Oxford Hip Score (P = .008), but not with
regard to the Forgotten Joint Score (P = .054).
CONCLUSION:
Only 20% of patients practiced
strenuous sports regularly or frequently after THA,
regardless of pain or discomfort. Participation
in sports after THA is strongly correlated with
motivation but not with level of discomfort. Longer
term studies with a greater focus on complications
and survival are necessary to determine whether
high-impact sports compromise patient safety or
implant

14. Recommendations arising from existing literature regarding restrictions
and benefits of sporting activities after joint replacement surgery vary
widely. As hip arthroplasty patients are becoming increasingly active,
their expectations about post-operative function are constantly
evolving. The aim of this study is to identify the perception of patients
regarding their performance in sportsactivities after hip arthroplasty.
METHODS:
This cross-sectional study included all patients undergoing
primary hip arthroplasty, for any diagnosis, between January 2009 and
January 2016. By applying a telephone survey, practice of sports before
surgery, resumption after surgery, level of performance, and causes of
non-resumption of sports activities were assessed.
RESULTS:
Data of 531 patients were obtained. Of these, 13% were engaged
in sports before surgery. The most frequently practiced sports were golf
(27.5%) and tennis (22%). Of the 72 patients that practiced sports, only
44.4% (30 patients) returned to this activity after surgery. Nonetheless,
71% of these patients reported to have an equal or better athletic
performance than before surgery. The main causes reported by patients
not to return to sports were the fear of injury and recommendation of
the surgeon.
CONCLUSIONS:
A significant number of patients return
to sports after hip arthroplasty and most of them perceive a good
athletic performance after surgery. These findings should enrich the pre-
operative assessment of patient's expectations, particularly for those
who wish to resume physical activity