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Driesman AS, Johnson RM, Yang CC, Miner TM, Dennis DA, Jennings JM. Return to Cycling After Total Joint Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00513-8. [PMID: 38768771 DOI: 10.1016/j.arth.2024.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND As total joint arthroplasty (TJA) candidates become younger, patients' expectations continue to expand. We surveyed our patient population to determine rates of return to cycling after TJA so that we could provide more accurate counseling on performance and safety. METHODS At our single institution, an online survey was generated and sent out to patients who had at least 3 months of follow-up. Patients were split into 4 categories based on surgery type: single total hip arthroplasty (THA), single total knee arthroplasty (TKA), multiple TJA, and revision TJA. RESULTS A total of 1,029 surveys fit the inclusion criteria. The average age of the patient population was 69 years, with an average of 4.08 years from their time of most recent TJA surgery (maximum follow-up of 18.61 years). Nearly all those who were able to bike prior to surgery were able to return to cycling, with only 6% not being able to do so. There were 41.8% who returned to cycling less than 3 months after surgery. Most cyclists were able to return to their previous level. Patients who had a revision TJA had significantly lower rates of returning to cycling in comparison to single TKA, single THA, and multi-TJA (37.3%, 60.3%, 61.9%, and 60.3%, respectively, P < .005). Patients who never returned to cycling had higher revision rates in comparison to those who were able to get back on a bike (14.4 versus 9.2%, P = .01). CONCLUSIONS A large proportion of patients who had prior cycling experience were able to return to bike riding within 3 to 6 months after TJA. Individuals who had revision TJA had lower rates of return to cycling in comparison to single TKA, single THA, and multi-TJA. Returning to cycling did not result in higher rates of revision.
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Affiliation(s)
| | | | | | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, Colorado; Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado; Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado; Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
| | - Jason M Jennings
- Colorado Joint Replacement, Denver, Colorado; Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
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Axelrod DE, Ekhtiari S, Winemaker MJ, de Beer J, Wood TJ. Management of Greater Trochanteric Pain Syndrome After Total Hip Arthroplasty: Practice Patterns and Surgeon Attitudes. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00005. [PMID: 38048139 PMCID: PMC10697621 DOI: 10.5435/jaaosglobal-d-23-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Greater trochanteric pain syndrome (GTPS) or trochanteric bursitis is described as pain on the lateral side of the hip that does not involve the hip joint and can be elicited clinically by palpation over the greater trochanter. To date, there remains no consensus on clinical guidelines for either diagnosis or management of GTPS. METHODS To understand the practice patterns, beliefs, and attitudes relating to the management of GTPS after total hip arthroplasty, a survey was developed and completed by Canadian arthroplasty surgeons. The final survey consisted of 23 questions divided into three sections: 1) screening questions; 2) demographic information; and 3) practice patterns, attitudes, and beliefs. RESULTS Most surgeons use physical examination alone for diagnosis. A detailed analysis indicates that surgeons primarily treat GTPS with oral anti-inflammatories (57.1%), structured physiotherapy (52.4%), and steroid injections (45.2%). Management options are typically nonsurgical and comprise a combination of either unstructured or targeted physiotherapy, corticosteroid injections, or platelet-rich plasma. DISCUSSION There remains an absence of clinical consensus for the diagnosis and management of GTPS after total hip arthroplasty. Physical examination is most often relied on, regardless of the availability of imaging aids. While common treatments of GTPS were identified, up to one-third of patients fail initial therapy.
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Affiliation(s)
- Daniel E. Axelrod
- From the Division of Orthopaedic Surgery, McMaster University, Hamilton, ON (Dr. Axelrod, Dr. Ekhtiari, Dr. Winemaker, and Dr. Wood), and the Hamilton Arthroplasty Group, Hamilton Health Sciences, Ontario, Canada (Dr. Winemaker and Dr. Wood)
| | - Seper Ekhtiari
- From the Division of Orthopaedic Surgery, McMaster University, Hamilton, ON (Dr. Axelrod, Dr. Ekhtiari, Dr. Winemaker, and Dr. Wood), and the Hamilton Arthroplasty Group, Hamilton Health Sciences, Ontario, Canada (Dr. Winemaker and Dr. Wood)
| | - Mitchell J. Winemaker
- From the Division of Orthopaedic Surgery, McMaster University, Hamilton, ON (Dr. Axelrod, Dr. Ekhtiari, Dr. Winemaker, and Dr. Wood), and the Hamilton Arthroplasty Group, Hamilton Health Sciences, Ontario, Canada (Dr. Winemaker and Dr. Wood)
| | - Justin de Beer
- From the Division of Orthopaedic Surgery, McMaster University, Hamilton, ON (Dr. Axelrod, Dr. Ekhtiari, Dr. Winemaker, and Dr. Wood), and the Hamilton Arthroplasty Group, Hamilton Health Sciences, Ontario, Canada (Dr. Winemaker and Dr. Wood)
| | - Thomas J. Wood
- From the Division of Orthopaedic Surgery, McMaster University, Hamilton, ON (Dr. Axelrod, Dr. Ekhtiari, Dr. Winemaker, and Dr. Wood), and the Hamilton Arthroplasty Group, Hamilton Health Sciences, Ontario, Canada (Dr. Winemaker and Dr. Wood)
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Factors affecting sports participation after total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:1181-1187. [PMID: 36799974 DOI: 10.1007/s00264-023-05724-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The purpose of this study was to investigate the rate of return to sports after total hip arthroplasty (THA) in patients who regularly participate in sports and evaluate the factors that can affect the return to sports. METHODS In total, 165 patients who had been continuously participating in sports prior to surgery were included from a total of 401 patients who underwent THA from 2015 to 2018. The mean follow-up was 3.3 (range, 2-6) years. Demographics, medical history, surgical parameters, functional outcomes, and anxiety about complications at the final follow-up were compared between the patients who participated in the same sports as before surgery (S group) and those who could not (N group). RESULTS The overall return to sports rate was 79% for 68 (41%) and 97 (59%) patients in the S and N groups, respectively. The most common sports that patients participated in post-operatively were walking (76 patients, 46%) and swimming (37 patients, 22%), followed by muscle training (25 patients, 15%). There were significant differences between the groups in the following patient factors: sex, primary disease, post-operative Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire outcome, and anxiety about falls and dislocation. In the evaluation of factors affecting return to sports using logistic regression analysis, male sex (odds ratio 3.66, 95% confidence interval 1.13-11.19, p = 0.029) and anxiety of dislocation (odds ratio 3.42, 95% confidence interval 1.58-7.42, p < 0.01) were extracted as independent risk factors. CONCLUSION Careful patient guidance and rehabilitation, in addition to accurate surgical procedures, will improve patient participation in sports.
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Sowers CB, Carrero AC, Cyrus JW, Ross JA, Golladay GJ, Patel NK. Return to Sports After Total Hip Arthroplasty: An Umbrella Review for Consensus Guidelines. Am J Sports Med 2023; 51:271-278. [PMID: 34668788 DOI: 10.1177/03635465211045698] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current recommendations on safe return to sports (RTS) after total hip arthroplasty (THA) are subjective and based on studies of varying quality. PURPOSE The aim of this study was to synthesize systematic reviews and meta-analyses on post-THA RTS to propose practice guidelines identifying which sports can be resumed, when they can be resumed, and what risks are present. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS This umbrella review followed the Joanna Briggs Institute (JBI) protocol and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Embase, Medline, and Cochrane databases were searched. Included studies were either systematic reviews or meta-analyses addressing primary or secondary outcomes. Outcomes of interest included safe sports after THA, time to RTS, prognostic indicators of RTS, reasons patients do not RTS, percentage of patients who RTS, implant complications, and objective classification of sports by impact level. Included reviews had data extracted and were assessed for methodological quality using the JBI protocol. The authors defined RTS as "returning to a sport the patient participated in at any point preoperatively." RESULTS Patients demonstrated a trend toward lower-impact sports postoperatively. Sports were classified as low (eg, walking), moderate (eg, downhill skiing), or high impact (eg, soccer). A total of 82% (range, 55%-104%) of patients were able to RTS at a mean time of 6 months (range, 4-7 months). The best prognostic indicator for RTS was previous experience in that sport. The main reason patients did not RTS was surgeon recommendation. Aseptic loosening was the most cited complication after RTS. CONCLUSION Most patients are able to return to preoperative levels of low- (eg, walking) and moderate-impact (eg, hiking) sports between 7 and 12 months after THA. Patients planning a return to high-impact (eg, singles tennis) sports should be counseled on the possible risks of traumatic injuries and aseptic loosening and monitored closely.
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Affiliation(s)
| | - Alberto C Carrero
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia, USA
| | - John W Cyrus
- Virginia Commonwealth University, School of Medicine; Richmond, Virginia, USA
| | - Jeremy A Ross
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia, USA
| | | | - Nirav K Patel
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia, USA
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Participation in Sports and Physical Activities After Total Joint Arthroplasty. J Arthroplasty 2022; 38:806-814.e5. [PMID: 36470366 DOI: 10.1016/j.arth.2022.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/02/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Quality data on physical activity participation following total joint arthroplasty (TJA) are limited. The purpose of this study was to explore patient participation, outcomes, and limitations in sports/physical activities following TJA. METHODS Patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a single institution from 2015 to 2020 were surveyed on sports/physical activity participation before and after TJA. Data were correlated with perioperative demographic and outcome scores. In total, 2,366 patients were surveyed: 788 (33.3%) underwent THA, 1,175 (49.7%) underwent TKA, and 403 (17.0%) underwent both THA/TKA. RESULTS Participation rates were 69.2, 61.5, and 61.3% at one year prior and 86.8, 81.5, and 81.6% at five years prior to THA, TKA, and THA/TKA, respectively. Participation rates were 73.1, 72.0, and 60.8% at mean 4.0 years postoperatively. Weekly time spent (P < .05) and exertion levels (P < .001) increased postoperatively for all three cohorts. For all three cohorts, the most common sports/activities were recreational walking, cycling, swimming, and golf, while intermediate- and high-impact activity participation decreased postoperatively. Independent predictors of postoperative sports/physical activity participation were younger age [THA (P < .001); TKA (P = .010)], lower body mass index [THA (P < .001); TKA (P < .001)], fewer comorbidities [THA (P < .001)], and higher postoperative Hip Injury and Osteoarthritis Outcome Score Junior[THA (P = .012)], Knee Injury and Osteoarthritis Outcome Score Junior[TKA (P = .004)], 12-Item Short Form Physical Component Score[THA (P < .001); TKA (P < .001); THA/TKA (P = .004)], and 12-Item Short Form Mental Component Score[TKA (P = .004)] scores. Activity restrictions were reported among 17.5, 20.9, and 25.1% of THA, TKA, and THA/TKA patients, respectively, and were more commonly self-imposed than surgeon-directed for all cohorts. CONCLUSION Though sports/physical activity participation may improve following TJA compared to one year preoperatively, participation is decreased compared to five years preoperatively, transitions to low-impact activities, and varies among subsets of patients.
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Mooiweer Y, Stevens M, van den Akker-Scheek I. Being active with a total hip or knee prosthesis: a systematic review into physical activity and sports recommendations and interventions to improve physical activity behavior. Eur Rev Aging Phys Act 2022; 19:7. [PMID: 35227191 PMCID: PMC8903715 DOI: 10.1186/s11556-022-00285-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/01/2022] [Indexed: 12/19/2022] Open
Abstract
Objectives Regular physical activity (PA) is considered important after total hip and knee arthroplasty (THA/TKA). Objective was to systematically assess literature on recommendations given by healthcare professionals to persons after THA and TKA and to provide an overview of existing interventions to stimulate PA and sports participation. Methods A systematic review with a narrative synthesis including articles published between January 1995 and January 2021 reporting on recommendations and interventions. The PubMed, Embase, CINAHL and PsycInfo databases were systematically searched for original articles reporting on physical activity and sports recommendations given by healthcare professionals to persons after THA and TKA, and articles reporting on interventions/programs to stimulate a physically active lifestyle after rehabilitation or explicitly defined as part of the rehabilitation. Methodological quality was assessed with the Mixed Methods Appraisal Tool (MMAT). The review was registered in Prospero (PROSPERO:CRD42020178556). Results Twenty-one articles reported on recommendations. Low-impact activities were allowed. Contact sports, most ball sports, and martial arts were not recommended. One study informed on whether health-enhancing PA recommendations were used to stimulate persons to become physically active. No studies included recommendations on sedentary behavior. Eleven studies reported on interventions. Interventions used guidance from a coach/physiotherapist; feedback on PA behavior from technology; and face-to-face, education, goal-setting, financial incentives and coaching/financial incentives combined, of which feedback and education seem to be most effective. For methodological quality, 18 out of 21 (86%) articles about recommendations and 7 out of 11 (64%) articles about interventions scored yes on more than half of the MMAT questions (0–5 score). Conclusion There is general agreement on what kind of sports activities can be recommended by healthcare professionals like orthopedic surgeons and physiotherapists. No attention is given to amount of PA. The same is true for limiting sedentary behavior. The number of interventions is limited and diverse, so no conclusions can be drawn. Interventions including provision of feedback about PA, seem to be effective and feasible. Supplementary Information The online version contains supplementary material available at 10.1186/s11556-022-00285-1.
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Affiliation(s)
- Yvet Mooiweer
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. BOX 30.001, 9700 RB, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. BOX 30.001, 9700 RB, Groningen, The Netherlands.
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, P.O. BOX 30.001, 9700 RB, Groningen, The Netherlands
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Bender A, Damm P, Hommel H, Duda GN. Overstretching Expectations May Endanger the Success of the “Millennium Surgery”. Front Bioeng Biotechnol 2022; 10:789629. [PMID: 35237570 PMCID: PMC8882767 DOI: 10.3389/fbioe.2022.789629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Total hip arthroplasty (THA) is an extremely successful treatment strategy. Patient expectations, however, have increased; if not properly guided by surgeons, at present, patients expect next to pain-free restoration of the joint and a fast return to work and sports. While the revision rates after THA also increased in younger patients, knowledge on musculoskeletal loads still remains sparse, and the current recommendations on postoperative rehabilitation are based on expert opinions only. The aim of this study was to unravel biomechanical contact conditions in “working age” (<60 years, 53.5 ± 3.0 years) and “retirement age” (>60 years, 67.7 ± 8.6 years) patients during activities recommended post-THA. We hypothesized that working age patients would show substantially increased hip contact loads compared to older patients. The in vivo joint contact force (Fres) and torsion torque (Mtors), reflecting the main contact load situation, experienced during activities of daily living and sports activities were measured in a unique group of 16 patients with instrumented THA. We summarized patient activities and sports recommendations after THA mentioned within the literature using PubMed (without claim of completeness). The measurements showed that younger working age patients experienced significant (p = 0.050) increased Mtors (21.52 ± 9.11 Nm) than older retirement age patients (13.99 ± 7.89 Nm) by walking. Bowling, as a recommended low-impact sport, was associated with Fres of up to 5436 N and Mtors of up to 108 Nm in the working age group, which were higher than the Fres (5276 N) and Mtors (71 Nm) during high-impact soccer. Based on our results, age was proven to be a discriminator in joint loading, with working age patients presenting with increased loads compared to retirement age patients, already during daily activities. The current patient recommendations have led to further increased joint loadings. If THA cannot be delayed in a patient, we propose counselling patients on a carefully considered return to sports, focusing on low-impact activities, as indicated hereby. The findings from this work illustrate the need to provide critical feedback to patient expectations when returning to work and sports activities. Patients returning to more intensive sports activities should be carefully monitored and advised to avoid as much overloading as possible.
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Affiliation(s)
- Alwina Bender
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
- *Correspondence: Philipp Damm,
| | - Hagen Hommel
- Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
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Mizoguchi Y, Urakawa T, Kurabayashi H. Safer return to jazz dance instruction after simultaneous bilateral total hip arthroplasty. BMJ Case Rep 2021; 14:14/7/e243214. [PMID: 34266826 PMCID: PMC8286752 DOI: 10.1136/bcr-2021-243214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
To describe the case of a 48-year-old Japanese female patient with more than two decades of experience in jazz dance instructor returning to work after simultaneous bilateral total hip arthroplasty (SBTHA). We provided her with a tailored postoperative physical therapy programme considering her preoperative activity level and skills using three-dimensional motion analysis for guidance. The patient returned to jazz dance instruction 8 months after undergoing SBTHA, and her disease-specific quality of life assessment score at 1-year postsurgery was almost perfect. Use of three-dimensional motion analysis helped facilitate our assessment of whether her hip angle was within the acceptable range for teaching the compound movements necessary in jazz dance, but her preoperative experience was crucial in determining her full-scale participation in jazz dance. At present, 7 years since the surgery, the patient is able to continue jazz dancing, the THA component remains stable.
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Affiliation(s)
- Yasuaki Mizoguchi
- Rehabilitation, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan .,Kimura Orthopeadic Clinic, Kumagaya, Saitama, Japan
| | - Tsukasa Urakawa
- Rehabilitation, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
| | - Hitoshi Kurabayashi
- Rehabilitation, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
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Thaler M, Khosravi I, Putzer D, Siebenrock KA, Zagra L. Return to Sports After Total Hip Arthroplasty: A Survey Among Members of the European Hip Society. J Arthroplasty 2021; 36:1645-1654. [PMID: 33277143 DOI: 10.1016/j.arth.2020.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The study's aim was to summarize the recommendations given by members of the European Hip Society (EHS) regarding sport activities after total hip arthroplasty (THA). METHODS Members of the EHS were invited to complete an online web-based questionnaire including recommendations for 47 sports disciplines. The questions regarding the specific sports were also divided into 4 subcategories: "allowed," "allowed when experienced," "not allowed", and "no opinion." Four intervals for resuming the sports activities after THA were evaluated: within 6 weeks after THA, 6 to 12 weeks after THA, 12 weeks to 6 months after THA, and more than 6 months after THA. Consensus on resuming sports was analyzed. RESULTS A total of 150 (32.9%) EHS members participated in the survey. Agreement was found for 5 sports activities in the first 6 weeks after THA, for 10 activities, 6 to 12 weeks after surgery, for 26 activities, 3 to 6 months after THA, and for 37 of 47 activities, 6 months after surgery. Sports activities which were not allowed after THA were handball, soccer and football, basketball, full contact sports, and martial arts. CONCLUSION This is the first report describing the recommendations of European hip arthroplasty surgeons on resuming sport activity after THA. Most physical activities were allowed for the patients 6 months after THA. The experience of the patient in performing a distinct sport activity did not influence the recommendations to return to former sports activities. European surgeons are progressively mitigating restrictions to sports after THA. Further studies should evaluate the effects of this trend on patients' outcome and implant survival.
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Affiliation(s)
- Martin Thaler
- Department of Orthopaedic Surgery and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ismail Khosravi
- Department of Orthopaedic Surgery and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
| | - David Putzer
- Department of Orthopaedic Surgery, Experimental Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, University of Bern, Bern Inselspital, Bern, Switzerland
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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Posner AD, Anoushiravani AA, Murtaza H, Roberts J. Late Anterior Prosthetic Hip Dislocation Due to Yoga. Arthroplast Today 2021; 8:84-88. [PMID: 34095399 PMCID: PMC8167316 DOI: 10.1016/j.artd.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 11/06/2022] Open
Abstract
The popularity of yoga and the prevalence of total hip arthroplasty (THA) have simultaneously increased in the United States. Accordingly, one can assume that the number of THA patients practicing yoga has increased. Certain yoga poses reach the extremes of hip range of motion, potentially leaving patients vulnerable to dislocation. To date, 2 cases of late posterior prosthetic hip dislocations during yoga have been reported; however, there have been no reports of anterior prosthetic hip dislocations. We present one case of late anterior prosthetic hip dislocation during yoga in a patient who underwent THA via the direct anterior approach. Prosthetic hip dislocation during yoga may be a growing concern. We provide additional evidence in support of recommendations for THA patients to safely practice yoga.
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Affiliation(s)
- Andrew D Posner
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | | | - Hamza Murtaza
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Jared Roberts
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Vu-Han T, Hardt S, Ascherl R, Gwinner C, Perka C. Recommendations for return to sports after total hip arthroplasty are becoming less restrictive as implants improve. Arch Orthop Trauma Surg 2021; 141:497-507. [PMID: 33258998 PMCID: PMC7899958 DOI: 10.1007/s00402-020-03691-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/11/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Total hip arthroplasty (THA) surgeries are expected to exponentially increase in the upcoming years, likely because of the overall broader indication of THAs. With these developments, an increasing number of younger (< 50 years) and active patients will receive surgical interventions, and expectations for an active lifestyle will accordingly increase. In addition, surgeons now have a growing array of techniques and implant materials to choose from. Despite these developments, evidence to provide the best standard-of-care to patients with high expectations for return to sports (RTS) is scarce and urgently needed. What recommendations do arthroplasty surgeons currently make to patients with high return to sports expectations, what factors may influence their recommendations and what surgical techniques and implant specifications are considered favorable in the treatment of patients with a more active lifestyle? This study was conducted to analyze the current recommendations, patient assessment, and patient counseling after THA to identify trends and relevant factors for surgical decision-making in patients with high-RTS expectations. MATERIAL AND METHODS We designed a questionnaire comprising five general items and 19 specific items that included 46 sub-items for hip arthroplasty and conducted a survey among 300 German surgeons specialized in arthroplasty at the German Arthroplasty Society (AE) to assess expert opinions, recommendations, surgical decision-making, and patient counseling for patients with high expectations for RTS after THA. RESULTS The majority of surgeons (81.9%) were in favor of RTS after THA. Risks associated with sports after THA were considered minimal (1%), with periprosthetic fractures ranking highest, followed by hip dislocation and polyethylene wear. Some surgical decision-making was influenced by high-RTS expectations in regard to implant fixation, stem type, femoral head diameter, and bearing-surface tribology. We observed an increasingly liberal counseling of patients for high-impact sports. CONCLUSION With the improvement of implants and surgical techniques, surgeons are more willing to encourage patients to adopt a more active lifestyle. However, the true long-term limitations need further investigation in future studies. LEVEL OF EVIDENCE 5 Expert opinions.
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Affiliation(s)
- T. Vu-Han
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - S. Hardt
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - R. Ascherl
- Department of Orthopaedic Surgery and Arthroplasty Nordoberpfalz AG, Krankenhaus Tirschenreuth, St.-Peter-Str. 31, 95643 Tirschenreuth, Germany
| | - C. Gwinner
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
| | - C. Perka
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin University Hospital, Chariteplatz 1, 10117 Berlin, Germany
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Rochoy M, Six J, Favre J, Lagrange N, Lefebvre JM, Rollier JC, Girard J. Does hip or knee joint replacement decrease chances to complete an ultra-trail race? Study in participants at the Ultra-Trail du Mont Blanc®. Orthop Traumatol Surg Res 2020; 106:1539-1544. [PMID: 33191172 DOI: 10.1016/j.otsr.2020.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 07/01/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The number of patients with hip or knee joint replacements is increasing. Some of these patients want to practice sport, including in high-impact sports such as ultra-trails. Is the proportion of drop-out higher among runners after a hip or knee replacement? What are the symptoms of these patients? HYPOTHESIS Hip or knee joint replacements are associated with a higher drop-out rate during an ultra-trail. MATERIAL AND METHODS We conducted a monocentric retrospective epidemiological study. A questionnaire translated into French, English and Spanish were sent to all runners registered for one or more of the 5 races of the 2015 to 2017 Ultra-Trail du Mont-Blanc® (UTMB®) editions. There were no exclusion criteria. The drop-out rate of patients who responded to the questionnaire was calculated among patients with and without hip or knee joint replacement. Specific symptoms related to these joint replacements were identified before, during and after the race. RESULTS Out of the 24,855 participants having run at least one of the 3 editions, 2,469 responded. Some of them ran several races: these 2469 runners were on 3171 start lines and 2548 finish lines (drop-out rate of 19.6%). Among these 2469 runners, 18 had hip and/or knee replacement and were on 27 start lines and 17 finish lines (drop-out rate of 37%). The race was finished by 3 of the 6 runners with a total hip arthroplasty (THA), all of the 8 runners with a hip resurfacing arthroplasty (HRA) and 3 of the 4 runners with a total knee arthroplasty (TKA). Among runners with THA, pubalgia or groin pain was described by one of them before the race, 3 during the race and 2 after the race. Among runners with HRA, pygalgia or groin pain was described by 2 of them during the race. As for the TKA, there was no specific symptom. No answering runner had a unicompartmental knee prosthesis. DISCUSSION Running ultra-trail is possible after a hip or knee joint replacement. All of the 8 runners with HRA finished the race. We may remain cautious about the long-term survival of prostheses. LEVEL OF PROOF IV; monocentric retrospective epidemiological study.
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Affiliation(s)
- Michaël Rochoy
- University Lille, 59000 Lille, France; Département de médecine générale, faculté de médecine, 59000 Lille, France; Université de Lille, CHU Lille, ULR 2694 - METRICS, CERIM, General Practice Department, 59000 Lille, France.
| | - Julien Six
- University Lille, 59000 Lille, France; Département de médecine générale, faculté de médecine, 59000 Lille, France; Université de Lille, General Practice Department, 59000 Lille, France
| | - Jonathan Favre
- University Lille, 59000 Lille, France; Département de médecine générale, faculté de médecine, 59000 Lille, France; Université de Lille, General Practice Department, 59000 Lille, France
| | | | - Jean-Marc Lefebvre
- University Lille, 59000 Lille, France; Département de médecine générale, faculté de médecine, 59000 Lille, France; Université de Lille, General Practice Department, 59000 Lille, France
| | - Jean-Charles Rollier
- Arthrosport Argonay, Clinique d'Argonay Ramsay Générale de Santé, 685, route des Menthonnex, 74370 Argonay, France
| | - Julien Girard
- University Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU Lille, 59000 Lille, France
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13
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Abstract
SUMMARY There is currently no consensus on the appropriate sports and occupational restrictions for military service members with a joint replacement. Data from the United States show that 14% of military patients complete an operational deployment after the index surgery. No published data are available on arthroplasty in the militaries of other North Atlantic Treaty Organization countries. Research is needed to determine the appropriate medical employment limitations for Canadian Armed Forces members with a knee or hip replacement. Service members wanting to continue military service should be carefully screened to ensure that their duties do not compromise the longevity of the implant and that the risk of mission-threatening complications is minimal.
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Affiliation(s)
- Max Talbot
- Department of Surgery, Division of Orthopaedic Surgery, McGill University, Montreal, Que. and Chief of Orthopaedic Surgery, Canadian Armed Forces
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14
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Payo-Ollero J, Alcalde R, Valentí A, Valentí J, Lamo de Espinosa J. Influence of total hip arthroplasty and physicians advices in the sports activity performed after the surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Payo-Ollero J, Alcalde R, Valentí A, Valentí JR, Lamo de Espinosa JM. Influence of total hip arthroplasty and physicians advices in the sports activity performed after the surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:251-257. [PMID: 32381395 DOI: 10.1016/j.recot.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/07/2019] [Accepted: 02/28/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There are no randomized prospective studies that evaluate sports activity after total hip arthroplasty (THA). The objective of this study is to assess the level and type of sports activity in patients undergoing THA and to assess the recommendations given by physicians. MATERIALS AND METHODS We performed a descriptive study that analyzes 46 patients (the average age was 41 years, range 37 - 48) under 50 years of age who underwent THA (58 hips) in our center. The average follow-up was 7.5 (1 - 11) years. Age, sex, sports activity according to the UCLA scale, sports activities practiced before and after the intervention, complications and recommendations given by doctors were evaluated. RESULTS The average time to resume sport activity after the surgery was 5 (3-10) months. There were no differences in the UCLA scale before and after the operation (P> 0.05). The most practiced sport before the surgery was swimming (17%). The 31% of patients did not receive advice from their physician and the 65.2% were dissuaded from playing sports after ATC. The recommended sports were swimming (44%) and the static bicycle (17.5%), correlating with the most practiced sports after the operation. CONCLUSION The patients modified their sport activity after having undergone a total hip arthroplasty. The surgery and the physician's advice were the ones that influenced the choice of the sports activity performed after being operated on.
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Affiliation(s)
- J Payo-Ollero
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España.
| | - R Alcalde
- Facultad de Medicina, Universidad de Navarra, Pamplona, España
| | - A Valentí
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España
| | - J R Valentí
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España
| | - J M Lamo de Espinosa
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España
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16
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Hoorntje A, Janssen KY, Bolder SBT, Koenraadt KLM, Daams JG, Blankevoort L, Kerkhoffs GMMJ, Kuijer PPFM. The Effect of Total Hip Arthroplasty on Sports and Work Participation: A Systematic Review and Meta-Analysis. Sports Med 2019; 48:1695-1726. [PMID: 29691754 PMCID: PMC5999146 DOI: 10.1007/s40279-018-0924-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Total hip arthroplasty (THA) is a successful procedure to treat end-stage hip osteoarthritis. The procedure is increasingly performed in adults of working age, who often wish to return to sports (RTS) and return to work (RTW). However, a systematic overview of the evidence on RTS and RTW after THA is lacking. Objectives Our aim was to systematically review (1) the extent to which patients RTS and RTW after THA, including (2) the time to RTS and RTW. Methods We searched MEDLINE and Embase from inception until October 2017. Two authors screened and extracted the data, including study information, patient demographics, rehabilitation protocols and pre- and postoperative sports and work participation. Methodological quality was assessed using the Newcastle–Ottawa scale. Data on pre- and postoperative sports and work participation were pooled using descriptive statistics. Results A total of 37 studies were included, of which seven were prospective studies and 30 were retrospective studies. Methodological quality was high in 11 studies, moderate in 16 studies, and low in ten 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. RTW was reported in 23 studies; the mean was 69%. Time to RTW varied from 1 to 17 weeks. Conclusion A great majority of patients RTS and RTW after THA within a timeframe of 28 and 17 weeks, respectively. For the increasingly younger THA population, this is valuable information that can be used in the preoperative shared decision-making process. Electronic supplementary material The online version of this article (10.1007/s40279-018-0924-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands. .,Academic Center for Evidence-Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Kim Y Janssen
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Stefan B T Bolder
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Joost G Daams
- Medical Library, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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17
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Meester SB, Wagenmakers R, van den Akker-Scheek I, Stevens M. Sport advice given by Dutch orthopaedic surgeons to patients after a total hip arthroplasty or total knee arthroplasty. PLoS One 2018; 13:e0202494. [PMID: 30161163 PMCID: PMC6116931 DOI: 10.1371/journal.pone.0202494] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 08/04/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The advice given to patients in the Netherlands regarding sport activities after total hip arthroplasty or total knee arthroplasty (THA/TKA) is currently based on the opinion of the individual orthopaedic surgeon. AIM To give an overview of the sport advice given by Dutch orthopaedic surgeons and to examine whether surgeons are familiar with the Dutch health-enhancing physical activity (PA) recommendations (NNGB). METHODS 472 surgeons were selected to fill in a questionnaire regarding 40 sport activities for four patient age groups (in years): 1) THA<65, 2) THA>65, 3) TKA<65 4) TKA>65. Surgeons were also asked if they discuss the role of PA postoperatively and about their knowledge and application of the NNGB. RESULTS There was consensus on 29 sport activities for the THA<65 group and 30 activities for the THA>65 group. In the TKA<65 group there was consensus for 33 sports activities and in the TKA>65 group for 32 activities. Amongst orthopaedic surgeons performing THAs and TKAs, respectively 77% and 79% discussed the role of PA postoperatively with their patients, and a total of 34% and 41% were familiar with the NNGB, with 33% and 34% of them giving NNGB-based advice. CONCLUSION Results can be used to recommend sport activities after THA/TKA. Although the majority of orthopaedic surgeons discuss the role of PA postoperatively with their patients, familiarity with health-enhancing PA recommendations is lacking.
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Affiliation(s)
- Sieger Bertus Meester
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert Wagenmakers
- Department of Orthopaedics, Amphia Hospital Breda, Breda, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Mears SC, Wilson MR, Mannen EM, Tackett SA, Barnes CL. Position of the Hip in Yoga. J Arthroplasty 2018; 33:2306-2311. [PMID: 29573916 DOI: 10.1016/j.arth.2018.02.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/30/2018] [Accepted: 02/16/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Yoga is growing in popularity as a form of exercise throughout the world. Orthopedic patients participate in yoga, yet little is known about the ranges-of-motion of the hip within various yoga poses. Orthopedic surgeons are unsure about what potential positions their patients are placing their hips during a yoga practice. The aim of this study is to quantify the degree of hip motion with common yoga poses. METHODS Twenty healthy, regular practitioners of yoga performed 11 different yoga poses in a standardized fashion. Motion analysis was used to capture range-of-motion of the hip during each pose. RESULTS Many yoga poses put the hip in extremes of motion. Poses such as downward dog, forward fold, seated twist, and pigeon stressed the hip in flexion. Warrior 1, warrior 2, crescent lunge, pigeon, and triangle stressed the hip in extension. Eagle and seated twist put the hip in higher adduction, while half moon, eagle, and triangle produced more hip internal rotation. CONCLUSION Many poses were found to reach extremes of hip motion. This study may help guide the orthopedic surgeon in counseling hip arthroplasty and hip impingement patients about yoga-related activity. By knowing which poses potentially stress the hip in particular planes of motion, surgeons may better inform their patients who are returning to yoga after injury or surgery.
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Affiliation(s)
- Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Margaret R Wilson
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Erin M Mannen
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - S Andrew Tackett
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
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Bonnin MP, Rollier JC, Chatelet JC, Ait-Si-Selmi T, Chouteau J, Jacquot L, Hannink G, Saffarini M, Fessy MH. Can Patients Practice Strenuous Sports After Uncemented Ceramic-on-Ceramic Total Hip Arthroplasty? Orthop J Sports Med 2018; 6:2325967118763920. [PMID: 29707594 PMCID: PMC5912283 DOI: 10.1177/2325967118763920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Patients are often concerned about returning to sports after total hip arthroplasty (THA). Purpose: To (1) evaluate sports participation and motivation rates in a large cohort of patients who underwent uncemented THA with ceramic-on-ceramic bearings and (2) determine whether patients’ participation was associated with their motivation for each sport, preoperative demographics, or patient-reported outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: 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 longevity.
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Affiliation(s)
- Michel P Bonnin
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.,Artro Group Institute, Lyon, France
| | - Jean-Charles Rollier
- Artro Group Institute, Lyon, France.,Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Jean-Christophe Chatelet
- Artro Group Institute, Lyon, France.,Centre de Chirurgie Orthopédique du Beaujolais, Arnas, France
| | - Tarik Ait-Si-Selmi
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.,Artro Group Institute, Lyon, France
| | - Julien Chouteau
- Artro Group Institute, Lyon, France.,Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Laurent Jacquot
- Artro Group Institute, Lyon, France.,Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Gerjon Hannink
- Orthopaedic Research Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Michel-Henri Fessy
- Artro Group Institute, Lyon, France.,Department of Orthopaedic Surgery and Sports Medicine, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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Hara D, Hamai S, Fukushi JI, Kawaguchi KI, Motomura G, Ikemura S, Komiyama K, Nakashima Y. Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy? Am J Sports Med 2017; 45:2468-2475. [PMID: 28586624 DOI: 10.1177/0363546517707942] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Periacetabular osteotomy (PAO) is an effective treatment for symptomatic acetabular dysplasia. However, whether postoperative participation in sports leads to progression of the Kellgren-Lawrence (KL) grade of osteoarthritis (OA) in these patients is unclear. PURPOSE To investigate (1) participation in sports before and after PAO and (2) whether postoperative participation in sports leads to progression of the KL grade. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The authors retrospectively reviewed data on 161 patients (183 hips) who underwent PAO for symptomatic acetabular dysplasia with preoperative KL grade 1 or 2 between 1998 and 2011. The mean age at the time of surgery was 42.0 ± 10.9 years (range, 12-64 years), and the mean follow-up duration was 100 months (range, 13-180 months). Data included participation in sports, the University of California, Los Angeles (UCLA) activity scale score, age at the time of surgery, body mass index, follow-up duration, history of treatment for developmental hip dislocations, Merle d'Aubigné-Postel score, Oxford Hip Score, center-edge angle, and KL grade. Univariate and multivariate analyses were applied to determine which factors were associated with progression to KL grade 3 or 4 after PAO. RESULTS The number of patients who participated in sports significantly increased from 50 (31.1%) preoperatively to 89 (55.3%) postoperatively. The mean UCLA score significantly increased from 4.7 ± 2.1 preoperatively to 5.5 ± 2.0 postoperatively. The KL grade progressed to grade 3 or 4 in 16 hips, including 4 hips that underwent conversion to total hip arthroplasty. No significant differences were found in postoperative participation in sports (89 hips [53.3%] vs 11 hips [68.8%], respectively; P = .24) and the UCLA score (5.6 ± 2.0 vs 5.1 ± 2.0, respectively; P = .30) between hips with KL grade 1 or 2 and KL grade 3 or 4. A multivariate analysis revealed that no factors, including postoperative participation in sports, were significantly associated with progression to KL grade 3 or 4. CONCLUSION Postoperative participation in sports after PAO did not significantly and negatively influence progression of the KL grade at midterm follow-up.
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Affiliation(s)
- Daisuke Hara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken-Ichi Kawaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Komiyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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