Sports activity after total hip and knee arthroplasty : specific recommendations concerning tennis

Return to athletics after total knee arthroplasty: a survey study of 784 recreational athletes across 12 sports

BACKGROUND

Postoperative return to recreational activity is a common concern among the increasingly active total knee arthroplasty (TKA) patient population, though there is a paucity of research characterizing sport-specific return and function. This study aimed to assess participation level, postoperative return to activity, sport function, and limitations for recreational athletes undergoing TKA.

METHODS

A survey of recreational sports participation among primary, elective TKA patients from a single academic center between June 2011 and January 2022 was conducted. Of the 10,777 surveys administered, responses were received from 1,063 (9.9%) patients, among whom 784 indicated being active in cycling (273 [34.8%]), running (33 [4.2%]), jogging (68 [8.7%]), swimming (228 [29.1%]), tennis (63 [8.0%]), skiing (55 [7.0%]), or high-impact team sports (64 [8.2%]) between two years preoperatively and time of survey administration, and were included for analyses.

RESULTS

Cycling (62.3% at two years preoperatively vs. 59.0% at latest follow-up) and swimming (62.7% at two years preoperatively vs. 63.6% at latest follow-up) demonstrated the most favorable participation rate changes, while running (84.0% at two years preoperatively vs. 48.5% at latest follow-up) and skiing (72.7% at two years preoperatively vs. 45.5% at latest follow-up) demonstrated the least favorable participation rate changes. The majority of respondents were "satisfied" or "very satisfied" with their return across all sports, though dissatisfaction was highest among runners and joggers. For cycling, running, jogging, and swimming, respondents most commonly reported no change in speed or distance capacity, though among these cyclists reported the highest rates of improved speed and distance. The majority of returning skiers reported improved balance, form, and ability to put on skis.

CONCLUSION

Return to sport is feasible following TKA with high satisfaction. Swimming and cycling represent manageable postoperative activities with high return-rates, while runners and joggers face increased difficulty returning to equal or better activity levels. Patients should receive individualized, sports-specific counseling regarding their expected postoperative course based on their goals of treatment.

Translation, Cross-Cultural Adaptation and Validation of the Chinese Version of the High Activity Arthroplasty Score

Background

The High Activity Arthroplasty Score (HAAS) is a validated score that assesses functional outcomes after lower limb arthroplasty, with fewer ceiling effects than other scores. The aim is to translate and cross-culturally adapt the HAAS into a Chinese version (HAAS-C) and to evaluate the psychometric properties of HAAS-C in patients after primary total knee arthroplasty (TKA).

Methods

A total of 104 patients diagnosed with knee osteoarthritis who had undergone TKA at least 12 months prior were recruited. A forward and backward translation procedure was performed for developing a culturally acceptable HAAS-C. Internal consistency was assessed using Cronbach's α, and test-retest reliability was measured using the intraclass correlation coefficient (ICC) within a 10-day interval. Construct validity was assessed by examining the correlations between HAAS-C and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQoL Group's five-dimension questionnaire (EQ-5D-5L), and Oxford knee score (OKS).

Results

HAAS-C demonstrated adequate Internal consistency reliability, as indicated by Cronbach's α coefficient of 0.75. Test-retest reliability yielded excellent results, with an ICC value of 0.98. Content validity indices were high, with a scale-level validity index of 0.9 and item-level validity indices greater than or equal to 0.8. HAAS-C showed a strong correlation with WOMAC (r = 0.69), a moderate correlation with EQ-5D-5L (r = 0.43), and OKS (r = 0.53) while exhibiting no floor or ceiling effects.

Conclusion

The validated HAAS-C questionnaire is a valid instrument for assessing patients undergoing TKA in mainland China.

Return to Sports Activity After Reverse Total Shoulder Arthroplasty

Background

There are little published data on return to sports (RTS) after reverse total shoulder arthroplasty (RTSA).

Purpose

To (1) determine the rate and timing of RTS after RTSA in an Asian population, (2) analyze predictive factors for RTS, and (3) determine the relationship between RTS after RTSA and clinical/radiological outcomes.

Study Design

Case-control study; Level of evidence, 3.

Methods

A retrospective review was performed on consecutive patients with diagnosis of irreparable rotator cuff tear (RCT), cuff tear arthropathy (CTA), or degenerative osteoarthritis who underwent RTSA between May 2017 and May 2020. Included were patients who played sports preoperatively in ≤3 years and had ≥2-year follow-up. Patients were divided into 2 groups based on responses to a telephone survey about RTS after RTSA: those who returned to sports (group A) and those who did not (group B). Patient characteristics, pre- and postoperative clinical features and functional scores, and radiologic outcomes (acromial fracture, scapular notching, heterotopic ossification, and loosening of humeral and glenoid component) were compared between the groups.

Results

Of 59 eligible patients, 44 patients (28 in group A, 16 in group B) were included. The RTS rate after RTSA was 63.6%, and the mean RTS time was 9.1 months (range, 3-36 months). There was a significant group difference in body mass index (BMI) (group A, 24.3 ± 2.1; group B, 27.1 ± 4.4; P = .01) and preoperative diagnosis (CTA/irreparable RCT/degenerative osteoarthritis diagnoses: group A, 13/12/3; group B, 3/6/7; P = .03). Patients in group A showed significantly higher forward flexion (P = .03) and higher Simple Shoulder Test score (P = .02) than group B at final clinical follow-up. No significant difference in radiological outcomes was found between the groups.

Conclusion

Patients with a low BMI and those diagnosed with CTA or irreparable RCT were found to have better RTS rates after undergoing RTSA, and forward flexion and Simple Shoulder Test scores at final follow-up were significantly higher in the RTS group, with no significant differences in complications.

Highly Crosslinked Polyethylene Can Reduce Wear Rate in THA for High-Demand Patients: A Matched-Paired Controlled Study

BACKGROUND

The average age of patients benefiting from total hip arthroplasty (THA) has been declining. In addition to pain relief, patients seek to return to physical activity. However, the latter may increase polyethylene wear and therefore the potential risk of early aseptic loosening. The introduction of highly crosslinked polyethylene (HXLPE) has reduced wear rates in the general patient population. The objective of this study was to evaluate the influence of impact sports in patients operated with THA using ceramic-on-conventional polyethylene (cPE) versus ceramic-on-HXLPE, in terms of wear and function, with a minimum of five year follow-up.

METHODS

Sixty-eight patients practicing an impact sport (University of California Los Angeles score ≥8) who underwent a primary THA were included: 34 with a ceramic-on-cPE versus 34 with a ceramic-on-HXLPE using the same cementless acetabular and femoral component. Patients were matched-paired by age, sex, BMI, and University of California Los Angeles score. The wear analysis was performed using the IMAGIKA software. The Harris hip score and hip and osteoarthritis outcome score were collected.

RESULTS

The linear wear rate was statistically higher (P < .0001) in the cPE group (0.13503 ± 0.0630 mm/year) than in the HXLPE group (0.03059 ± 0.0084 mm/year). Postoperatively, the increase in Harris hip score was calculated at 37.64 for the entire cohort and was comparable in both groups (P = .3674). The hip and osteoarthritis outcome score for pain (P = .0009), daily life activities (P = .0016), and quality of life (P = .0179) were significantly higher in the HXLPE group, with, between groups, a difference inferior to the reported minimal clinical important difference. Three patients exhibited signs of periprosthetic osteolysis in the cPE group, one on the femoral side and two on the acetabular side. None were observed in the HXLPE group. No revision for aseptic loosening was reported in both cohorts.

CONCLUSION

Patients partaking in impact sports and receiving a ceramic-on-HXLPE THA demonstrated lower wear and osteolysis rates than those having a ceramic-on-cPE THA, with similar functional results.

Comparison of clinical characteristics and 10-year survival rates of revision hip arthroplasties among revision time groups

INTRODUCTION

No significant regression has been reported in revision total hip arthroplasty (THA) rates despite substantial progress in implant technologies and surgical techniques. It is critical to investigate how patient demographics, THA indications, surgical techniques, types of implants, and other factors influence the frequency of early and late revision surgery. The main purpose of the present study was to evaluate the clinical characteristics and 10-year survival rates of revision hip arthroplasties among revision time groups.

MATERIAL AND METHODS

The clinical data of 396 patients who underwent revision hip arthroplasty between 2005 and 2011 were evaluated in this multi-centre study. Patients were assigned to one of four revision time groups based on the interval between the index hip arthroplasty and the revision surgery (< 2, 2-5, 5-10, and > 10 years).

RESULTS

There were significant differences among revision time groups in terms of aetiology for primary hip arthroplasty, indications for revision hip arthroplasty, and types of revision procedures. Patients with hip dysplasia more frequently received revision hip arthroplasty within 2 years in contrast to those with osteoarthritis. Revision hip arthroplasties due to periprosthetic infection and instability were conducted earlier compared to aseptic loosening. The overall 10-year survival rate of revision hip arthroplasty was 83.2%, and it was highest for the very early revisions (< 2 years).

CONCLUSIONS

According to our results, early revision hip arthroplasty was found to be mostly dependent on surgery-related factors rather than demographic factors. On the other hand, we observed that survival rates of very early revision hip arthroplasties are higher than late revision hip arthroplasties.

Return to Sport Activity in the Elderly Patients after Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis

In patients with knee osteoarthritis, when only medial or lateral compartment of the knee is involved, unicompartimental knee arthroplasty (UKA) is a reliable option for addressing the symptoms and restore function. The main aim of the present review is to systematically collect the available evidence concerning the return to sport activity in the elderly patients after UKA. An electronic search was carried out on the following databases; Pubmed-Medline, Cochrane central, and Scopus, searching for randomized controlled trials, prospective cohort studies, retrospective case-control studies, and case series. Data concerning the evaluation of the return to sport (RTS) and of functional outcomes in the elderly patients after UKA surgery. MINORS score was used to assess the risk of methodological biases. Odds ratios and raw proportions were used to report the pooled effect of UKA on the return to sport in comparative and non-comparative studies, respectively. Same level RTS in elderly patients was of 86% (pooled return proportion 0.86, 95%CI 0.78, 0.94), showing also better relative RTS and time to RTS of patients undergoing UKA, in comparison to those undergoing TKA. Sport-specific RTS showed that higher return rates were observed for low-impact sports, whereas high-impact sports prevented a full return to activities. UKA is a valid and reliable option for elderly patients to satisfactorily resume their sport practice, especially for low impact activities. The rate of return to sports following UKA is higher than TKA.

Influence of total hip arthroplasty and physicians advices in the sports activity performed after the surgery

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.

Return to Recreational Sport Following Lumbar Fusion

STUDY DESIGN

This was a retrospective questionnaire study at a single academic medical center.

OBJECTIVE

The objective of this study was to obtain information on rates of return to sport following lumbar fusion as well as sport-specific effects to improve evidence-based preoperative patient counseling.

SUMMARY OF BACKGROUND DATA

Lumbar spinal fusion is one of the fastest-growing surgical procedures, with the majority being in patients aged 60 years and older. Remaining active is an important consideration for elderly patients undergoing lumbar spinal fusion. Golf, swimming, and biking are common forms of recreational exercise for an older population in whom lumbar fusion is often performed. There is a lack of data in the current literature regarding rates of return to recreational sporting activities following elective lumbar fusion.

METHODS

Following Institutional Review Board approval, all patients undergoing lumbar fusion at a single institution from 2012 to 2016 were screened and included in this study. A minimum of 1-year postoperative follow-up was required. A total of 117 patients were identified undergoing single-level or multilevel lumbar fusion during this time period. The average age was 63 years. Questionnaires were obtained to screen and identify patients who participated in 1 of 3 recreational sports before surgery (golf, swimming, and biking). Preoperative and postoperative collected outcome measures were then compared using the Student t test.

RESULTS

Of the 117 identified lumbar fusion patients, 32 patients (27%) participated in 1 of the 3 most common recreational sporting activities of golf, swimming, or biking. Within the golf cohort (n=13), 100% of patients returned to recreational golfing postoperatively. There was a statistically significant reduction in Visual Analog Scale (VAS) pain scores postoperatively (6.3±3.7-1.8±2.4, P=0.01). Driving distance was reduced postoperatively (223.3±42.7-212.1±44.4 yards, P=0.042) and handicaps increased (12.8±8.4-17.0±11.4, P=0.02). Within the swimming cohort (n=9), 100% of patients returned to recreational swimming following lumbar fusion. There was a statistically significant reduction in VAS pain scores postoperatively (9.1±1.7-2.2±2.3, P=0.01). There was a trend towards increased amounts of swimming (times per week) postoperatively, however, this was not statistically significant (2.1±1.7-3.7±1.5, P=0.10). Within the biking cohort (n=10), 100% of patients returned to recreational biking following lumbar fusion. There was a statistically significant reduction in VAS pain scores postoperatively (6.7±4.0-1.3±1.7, P=0.03). There was a trend towards increased amounts of biking (times per week) postoperatively, however, this was not statistically significant (2.5±1.8-3.7±1.6 postoperatively, P=0.20).

CONCLUSIONS

In the cohort of patients from this study who partook in golfing, swimming or bicycling, 100% were able to return to their respective sport by 3-9 months postoperatively and all had a significant reduction in pain. With regards to golfers, lumbar fusion likely has an adverse effect on their golfing ability with an increase in handicap and an expected reduction in driving distance.

Activity following reverse total shoulder arthroplasty: What should surgeons be advising?

BACKGROUND

Reverse total shoulder arthroplasty (RTSA) is now the most frequently performed form of shoulder arthroplasty. There is currently no consensus on recommended levels of activity and sport following RTSA. The aim of this review is to outline the current evidence and provide a guide for surgeons on what to advise their patients regarding activity level following RTSA.

METHODS

A systematic review of the literature was performed using the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed using the electronic databases PubMed and Medline. Included studies were of level 1 to 4 evidence in the English language evaluating complications and return to sport after RTSA.

RESULTS

Eleven studies were selected and included a total of 621 patients (67% female) with a mean age of 73 years (range 22-92). All of the included patients participated in sports prior to RTSA. The rate of return to sport ranged from 60 to 86% and varied with the level of sport activity. Mean time to return to sport after surgery varied greatly between studies.

CONCLUSIONS

Return to sport is tolerated following RTSA; however, studies are short to medium term only and although the reported complication rate is low, the studies did not include radiographic evaluation. Longer term studies with subgroup analysis evaluating common recreational activities after RTSA are required, particularly in the younger population, in order to establish clear post-operative guidelines.

Return to Golf After Arthroscopic Management of Femoroacetabular Impingement Syndrome

PURPOSE

To investigate if patients who reported playing golf before arthroscopic hip surgery for femoroacetabular impingement syndrome were able to return to playing golf postoperatively.

METHODS

The study was a retrospective analysis of all consecutive patients undergoing hip arthroscopy for femoroacetabular impingement syndrome between 2012 and 2014. Inclusion criteria required that a patient (1) reported playing golf before the surgery, (2) had a minimum 2-year follow-up, and (3) completed patient-reported outcome measures. An electronic postoperative return to golf questionnaire was completed by patients who reported golf as an activity. To evaluate patients' ability to return to golf after surgery, the following variables were analyzed with paired samples t test and χ-square tests: handedness, holes played, modified-Harris Hip Score, and Hip Outcome Score Activity of Daily Living and Sports-Specific Subscale.

RESULTS

A total of 29 patients (22 men; age, 36.0 ± 11.9 years) with a minimum of 24 months of follow-up who self-reported playing golf preoperatively were included in the analysis. Preoperatively, 23 patients (79%) had discontinued golfing owing to activity-related hip complaints. At the final follow-up, all patients had significant improvements in the Hip Outcome Score Activity of Daily Living (preoperatively, 65.9 ± 19.9; postoperatively, 91.5 ± 12.8; P < .0001), the Hip Outcome Score Sports-Specific Subscale (38.2 ± 23.5, 79.7 ± 28.8; P = .0002), and modified-Harris Hip Score (54.8 ± 15.6; 84.2 ± 15.8; P < .0001). Additionally, there was a decrease in pain from 7.34 ± 1.63 to 1.71 ± 2.3 postoperatively (P < .0001), and 97% of patients returned to golf at an average of 7.2 months postoperatively. Postoperatively, 55% of patients (n = 16) noted improved golfing performance, 41% (n = 11) returned to their preinjury level, 1 patient (3%) returned at a lower level owing to non-hip-related problems, and 1 (3%) did not return to golf owing to fear of reinjury.

CONCLUSIONS

Arthroscopic treatment of femoroacetabular impingement syndrome in patients who reported playing golf before surgery resulted in significant improvements in hip function and predictably high rates of patient satisfaction, with 97% returning to golfing activity and 55% noting improvement from preinjury sporting performance.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Return to sports and work after partial shoulder replacement surgery

BACKGROUND

Shoulder hemiarthroplasty is a particularly attractive treatment option in young active patients, where revision surgery is an issue and a glenoid replacement might be necessary in the long run. These patients often ask about the possibility of returning to sport and work after surgery.

OBJECTIVE

The purpose of this investigation was to analyze whether patients undergoing shoulder hemiarthroplasty (HSA) are able to successfully return to sports activities and work after surgery.

MATERIALS AND METHODS

This study included 42 patients treated with HSA. Two subgroups were built: patients who had participated in sports less than 5 years prior to surgery (group A: n = 29, 69%) and those who had not done so (group B: n = 13, 31%). Evaluation was based on a questionnaire asking about types of sports, frequency of sports activity, and the time taken to return to sports and work, as well as about limitations in occupational life.

RESULTS

Patients' mean age at the time of surgery was 56.3 ± 12.7 years in group A and 66.9 ± 13.8 years in group B. Mean follow-up was 5.5 years (range 2.5-12 years). In group A, 18 patients (62%) had participated in sports up to the time of surgery and 12 (41%) had returned to the same level of sports activity at final follow-up. The rate of return to preoperative sports activity was 67%. Swimming was one of the most favorable sports (92%). Of the cohort patients, 2 (5%) had to change their profession due to surgery. Most patients were retired at follow-up.

CONCLUSION

Patients who were sportingly active prior to HSA were able to return to sports after surgery in 67% of cases. This study confirms that patients treated by hemiarthroplasty of the shoulder joint can return to sports and work, even at medium-term follow-up.

Sport advice given by Dutch orthopaedic surgeons to patients after a total hip arthroplasty or total knee arthroplasty

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.

Getting back in the game after humeral head resurfacing

Background

Aim of this investigation was to analyze whether patients undergoing humeral head resurfacing (HHR) surgery are able to successfully return to their sports and occupation afterwards.

Materials and methods

Fifty patients treated with CUP (HHR) arthroplasty were included. Two groups were built: Patients who have participated in sports less than 5 years prior surgery (Group 1: n = 42 (84%)) and patients who have never participated in sports (Group 2: n = 8 (16%)). Evaluation was based on a questionnaire asking for types of sports, frequency, time to return to sports and work as well as limitations in work life.

Results

Mean age at the time of surgery was 58.6 (36-84) years in Group 1 and 65 (56-75) years in Group 2. Mean time follow-up was 5.5 years (2.5-12) years. Twenty-seven (64%) patients in Group 1 participated in sports right before surgery. Twenty-one patients (50%) returned to sports after surgery. The returning rate was 78%. Seven (17%) patients in Group 1 stated that the reason they underwent shoulder replacement surgery was to continue to participate in sports. Swimming and skiing were two of the most favorable sports. Two (4%) patients had to change their profession due to surgery. Most of the patients were retired at follow-up.

Conclusion

Most of the active patients undergoing HHR surgery are successfully able to return to their sports activities after surgery. Patients employed were able to return to their occupation after surgery. Many patients were already retired at the time of follow up.

Can Patients Practice Strenuous Sports After Uncemented Ceramic-on-Ceramic Total Hip Arthroplasty?

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.

Sports Activity Following Cementless Metaphyseal Hip Joint Arthroplasty

An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients' willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.

RETORNO AO ESPORTE APÓS ARTROPLASTIA TOTAL DO JOELHO: REVISÃO SISTEMÁTICA

RESUMO Esta revisão sistemática da literatura teve como objetivo analisar as variáveis envolvidas no retorno às atividades esportivas em pacientes submetidos à artroplastia total do joelho (ATJ), verificar o tipo de esporte recomendado, o tempo de retorno ao esporte, a satisfação do paciente e o nível de atividade física após a cirurgia. Os estudos relacionados com a prática de atividade física e desportiva depois da ATJ foram selecionados por dois revisores independentes. Foram incluídos 11 estudos (10 transversais retrospectivos e um caso-controle). A maioria dos pacientes que participou de alguma atividade física regular antes da ATJ retornou à prática esportiva após a cirurgia, sendo mais comuns os esportes de baixo impacto como caminhada, esportes aquáticos, golfe, bicicleta estacionária, entre outros. Foi possível observar que o nível de atividade física não depende da dor e dos sintomas pós-operatórios, mas da satisfação com a cirurgia, motivação e capacidade funcional dos indivíduos. O tempo de retorno ao esporte variou de seis a 18 meses depois da ATJ. Apesar de alguns estudos mostrarem que os cirurgiões não recomendam a prática de esportes de alto impacto após a cirurgia, alguns estudos mostraram bons resultados, desde que o nível de atividade prévio à cirurgia, a população adequada e a expectativa do paciente no pós-operatório sejam considerados. Assim, conclui-se que o retorno ao esporte após ATJ não só é possível, como é recomendado em níveis recreativos, e um paciente colaborativo, instruído e com preparo adequado de condicionamento físico pode melhorar tanto no nível funcional e cardiovascular quanto no psicológico, com aumento da autoestima e da qualidade de vida. Há ainda a necessidade de estudos futuros, de boa qualidade metodológica como os ensaios clínicos randomizados, sobre os efeitos (benefícios e prejuízos) dos esportes de alto impacto para os pacientes submetidos à ATJ.

Return to Golfing Activity After Joint Arthroplasty

BACKGROUND

Many patients who are considering total joint arthroplasty, including hip, knee, and shoulder replacement, are concerned with their likelihood of returning to golf postoperatively as well as the effect that surgery will have on their game.

PURPOSE

To review the existing literature on patients who have undergone major joint arthroplasty (hip, knee, and shoulder), to examine the effects of surgery on performance in golf, and to provide surgeon recommendations as related to participation in golf after surgery. A brief review of the history and biomechanics of the golf swing is also provided.

STUDY DESIGN

Systematic review.

METHODS

We performed a systematic review of the literature in the online Medline database, evaluating articles that contained the terms "golf" and "arthroplasty." Additionally, a web-based search evaluating clinical practice recommendations after joint arthroplasty was performed. The research was reviewed, and objective and anecdotal guidelines were formulated.

RESULTS

Total joint arthroplasty provided an improvement in pain during golfing activity, and most patients were able to return to sport with variable improvements in sport-specific outcomes.

CONCLUSION

In counseling patients regarding the return to golf after joint arthroplasty, it is our opinion, on the basis of our experience and those reported from others in the literature, that golfers undergoing total hip, knee, and shoulder arthroplasty can safely return to sport.

Activity levels after reverse shoulder arthroplasty

BACKGROUND

Aim of this study was to analyze whether patients undergoing reverse shoulder arthroplasty (RSA) surgery are able to successfully return to sports and afterwards.

METHODS

Thirty-eight patients treated with RSA for Cuff Tear Arthropathy (CTA) were included. Two sub-groups were built: Patients who have participated in sports activities within the last 5 years prior surgery [Group A: n = 21 (55 %)] and patients who have never participated in sports [Group B: n = 17 (45 %)]. Evaluation was based on a questionnaire asking types of sports, frequency, and time to return to sports.

RESULTS

Mean age in Group A at the time of surgery was 76.2 (65-85) years and 78.4 (68-92) years in Group B. Most patients were women [n = 35 (92 %)]. Mean follow-up was 4.8 years (2.4-9.4) years. Fifteen (71 %) patients in Group A participated in sports at the time prior to surgery. Fourteen (67 %) patients returned to sports after surgery. The returning rate was 93 %. Six (29 %) patients of Group A stated that one reason they underwent shoulder replacement surgery was to continue to participate in sports. All active patients performed swimming at final follow up.

CONCLUSIONS

Most patients being active prior to reverse shoulder arthroplasty surgery are successfully able to return to their activity afterwards.

Return to Sports and Physical Activity After Total and Unicondylar Knee Arthroplasty: A Systematic Review and Meta-Analysis

BACKGROUND

People today are living longer and want to remain active. While obesity is becoming an epidemic, the number of patients suffering from osteoarthritis (OA) is expected to grow exponentially in the coming decades. Patients with OA of the knee are progressively being restricted in their activities. Since a knee arthroplasty (KA) is a well accepted, cost-effective intervention to relieve pain, restore function and improve health-related quality of life, indications are expanding to younger and more active patients. However, evidence concerning return to sports (RTS) and physical activity (PA) after KA is sparse.

OBJECTIVES

Our aim was to systematically summarise the available literature concerning the extent to which patients can RTS and be physically active after total (TKA) and unicondylar knee arthroplasty (UKA), as well as the time it takes.

METHODS

PRISMA guidelines were followed and our study protocol was published online at PROSPERO under registration number CRD42014009370. Based on the keywords (and synonyms of) 'arthroplasty', 'sports' and 'recovery of function', the databases MEDLINE, Embase and SPORTDiscus up to January 5, 2015 were searched. Articles concerning TKA or UKA patients who recovered their sporting capacity, or intended to, were included and were rated by outcomes of our interest. Methodological quality was assessed using Quality in Prognosis Studies (QUIPS) and data extraction was performed using a standardised extraction form, both conducted by two independent investigators.

RESULTS

Out of 1115 hits, 18 original studies were included. According to QUIPS, three studies had a low risk of bias. Overall RTS varied from 36 to 89% after TKA and from 75 to >100% after UKA. The meta-analysis revealed that participation in sports seems more likely after UKA than after TKA, with mean numbers of sports per patient postoperatively of 1.1-4.6 after UKA and 0.2-1.0 after TKA. PA level was higher after UKA than after TKA, but a trend towards lower-impact sports was shown after both TKA and UKA. Mean time to RTS after TKA and UKA was 13 and 12 weeks, respectively, concerning low-impact types of sports in more than 90 % of cases.

CONCLUSIONS

Low- and higher-impact sports after both TKA and UKA are possible, but it is clear that more patients RTS (including higher-impact types of sports) after UKA than after TKA. However, the overall quality of included studies was limited, mainly because confounding factors were inadequately taken into account in most studies.

Patient Activity Levels After Reverse Total Shoulder Arthroplasty: What Are Patients Doing?

BACKGROUND

The indications for reverse total shoulder arthroplasty (RTSA) continue to expand, which has resulted in younger patients who want to remain active after RTSA. Little information is available to manage expectations of both physicians and patients for return to sporting activities.

PURPOSE

To determine the rate of return to sporting activities and assess average time to return to sports after RTSA.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

This was a retrospective review of consecutive RTSA patients collected from our institution's shoulder arthroplasty registry. All patients who played sports preoperatively and had a minimum of 1-year follow-up were included. Final follow-up consisted of an additional patient-reported questionnaire with questions regarding physical fitness and sporting activities. Each patient also completed an assessment with the American Shoulder and Elbow Society (ASES) Shoulder Score and a visual analog scale (VAS) for pain.

RESULTS

Seventy-six patients played a sport preoperatively and met inclusion and exclusion criteria. The average follow-up was 31.6 months (range, 12-65 months), and average age was 74.8 years (range, 49.9-92.6 years). Average VAS pain scores improved from 6.57 to 0.63 (P < .001). Average ASES scores improved from 34.30 to 81.45 (P < .001). Subjectively, 11.8% of patients complained of stiffness and 10.5% complained of chronic pain. After RTSA, 85.5% of patients returned to at least 1 sport. Average time to return to full sports was 5.3 months. Fitness sports had the highest direct rate of return (81.5%), followed by swimming (66.7%), running (57.1%), cycling (50.0%), and golf (50%). Postoperatively, 41.1% of patients reported improved physical fitness; 88.2% felt that their sports outcome was good to excellent, and 93.4% felt that their surgical outcome was good to excellent.

CONCLUSION

Patients undergoing RTSA had an 85% rate of return to 1 or more sporting activities at an average of 5.3 months after surgery. Age greater than 70 years was a significant predictor of decreased return to activities. The present study offers valuable information to help manage patient and surgeon expectations.

Total knee replacement arthroplasty with Buechel and Pappas knee: minimum 2-year follow-up

Background

Clinical and radiologic evaluation and analyses of the surgeries using Buechel and Pappas (B-P) knee implants.

Methods

The study was conducted on 60 patients who underwent 94 total knee replacement arthroplasty with B-P knee implants from May 2009 to December 2010. The results were compared to the results of 41 patients who underwent 60 knee joint surgeries using NexGen-LPS implants from January 2008 to August 2009.

Results

The American Knee Society score of the B-P knee group increased from an average of 66.9 (clinical score) and 65.5 (functional score) to 93.4 and 90.3, respectively; while those for the NexGen-LPS group increased from an average of 68.8 (clinical score) and 62.4 (functional score) to 86.3 and 76, respectively. The average ranges of motion of the B-P knee group and the NexGen-LPS group were 119.1° and 114.8°, respectively, before surgery and improved to 121.0° and 123.0° at final follow-up after the surgery. The visual analogue scale scores for the B-P knee group and the NexGen-LPS group improved from 4.7 and 4.6 to 1.4 and 1.8, respectively. The flexion contracture also improved from 5.1° and 6.3° to 0.64° and 1.72°. The tibio-femoral angle for the B-P knee group and the NexGen-LPS group also improved greatly after the surgery, from varus 0.34° and 0.73° each to valgus 6.7° and 6.9°, respectively.

Conclusions

The evaluation of more than 2 years of total knee replacement arthroplasty using B-P knee implants showed good results. B-P knee implants showed a relatively higher degree of satisfaction in clinical knee score and less intraoperative bone mass removal than NexGen-LPS implants.

Outcomes of post-operative periprosthetic acetabular fracture around total hip arthroplasty

Post-operative periprosthetic acetabular fractures are rare, but serious complication following total hip arthroplasty (THA). As the number of THA performed each year increases so will the expected number of periprosthetic fractures, thus making the treatment of these fractures an important topic for discussion. The purpose of this review is to analyze the recent evidence on risk factors, fracture classification schemes and treatment strategies that have been used for periprosthetic acetabular fractures around THA. The modified Paprosky classification is the most widely used and is a useful guide for management strategies. This classification system provides the guidelines for developing multiple treatment algorithms for decision making. Treatment options for surgical management include open reduction and internal fixation with plating, use of reconstruction cages, trabecular metal augments and bone grafting as needed. Treatment decisions are still an area of controversy and current research.

Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement

There is little in the literature on the level of participation in sports which patients undertake after total hip replacement (THR). Our aims in this study were to determine first, the level of sporting activity, second, the predictive factors for returning to sporting activity, and third, the correlation between participation in sports and satisfaction after THR. We retrospectively identified 815 patients who had undergone THR between 1995 and 2005. All were asked to complete a self-administered questionnaire regarding their sporting activity. A total of 571 patients (71%) met the inclusion criteria and completed the evaluation. At a mean follow-up of 9.8 years (sd 2.9), 366 patients (64%) returned to sporting activity as defined by a University of California at Los Angeles (UCLA) score of > 5. The main reasons that patients had for refraining from sports were fear of dislocation (65; 31.6%), avoiding wear (52; 25.4%), and the recommendation of the surgeon (34; 16.6%). There was a significant relationship between higher post-operative participation in sport in those patients with a higher pre-operative Harris hip score (HHS) (p = 0.0074), motivation to participate in sporting activities (p = 0.00022) and a shorter duration of symptoms (p = 0.0034). Finally, there was a correlation between age (p = 0.00013), UCLA score (p = 0.012) and pre-operative HHS (p = 0.00091) and satisfaction.

In conclusion, we found that most patients participate in sporting activity after THR, regardless of the advice of their surgeon, and that there is a correlation between the level of participation and pre-operative function, motivation, duration of symptoms and post-operative satisfaction.

Cite this article: Bone Joint J 2014;96-B:1041–6

Total hip and knee replacement in the mature athlete

Context:

Total hip replacement and total knee replacement are among the most successful and common surgical procedures in orthopaedics. These operations were traditionally reserved for older, sedentary patients. However, these are now being increasingly performed in patients expecting to return to athletic activities.

Evidence Acquisition:

The peer-reviewed medical literature was searched via PubMed from the years 2000 to 2013. Those studies pertinent to modern hip and knee replacement in an athletic population were selected for inclusion.

Study Design:

Literature review.

Level of Evidence:

Level 4.

Results:

There is a lack of high-quality evidence in the peer-reviewed literature relating to the replacement of hips and knees in younger athletic patients. Although many patients undergoing joint replacement are active in recreational activities, a minority engage in high-impact sports. Following surgery, overall activities tend to increase, but high-demand athletic activities may be limited by pain, functional outcome, or activity restrictions imposed by health care providers.

Conclusion:

Patients receiving hip and knee replacements should be counseled in that returning to high-impact and repetitive-loading athletic activities after surgery may shorten the life span of their implant.

Strength-of-Recommendation Taxonomy (SORT):

C.

Return to judo after joint replacement

PURPOSE

The main purpose of this study was to investigate whether judo could be practised after joint replacement.

METHODS

Two hundred and twelve questionnaires were sent to Judokas licensed at the French Judo Federation, over the age of 60, with at least a black belt 6th Dan. Out of 83 responses, 38 individuals, mean age 72.8 ± 7.9 years old, had at least one implant. The survey identified 36 total hip arthroplasties (THA) in 27 patients, 10 total knee arthroplasties (TKA) in 8 patients and 3 total shoulder arthroplasties (TSA) in 3 patients. The main evaluation criterion was the return to judo after joint replacement. Secondary criteria were the level of judo after surgery, rate of surgical revision at the final follow-up and the level of patient satisfaction.

RESULTS

Twenty-nine out of 38 patients who underwent joint replacement returned to judo practice (76.3 %) a mean 4.1 ± 2.9 months after surgery. On the other hand, all patients stopped competitive judo. The surgeon recommended 65.8 % of these patients to stop practising judo. There were 2 surgical revisions in the THA group (5.5 %) for loosening at 6 and 9 years of follow-up. No dislocations or fractures were reported at the final follow-up. Thirty-two patients (84.2 %) were satisfied with their implant.

CONCLUSION

The practice of judo does not seem to be limited by joint replacement. A clinical and radiological study should be performed to confirm these results.

Does impact sport activity influence total hip arthroplasty durability?

BACKGROUND

Return to sport is a key patient demand after hip arthroplasty and some patients are even involved in high-impact sports. Although polyethylene wear is related to the number of cycles and the importance of the load, it is unclear whether high-impact sport per se influences THA durability.

QUESTIONS/PURPOSES

Therefore, we compared (1) function between the patients involved in high-impact sports and the patients with lower activities as measured by the Harris hip score (HHS) and the Hip Osteoarthritis Outcome Score (HOOS); (2) linear wear rates; and (3) survivorships considering revision for mechanical failure with radiographic signs of aseptic loosening as the end point.

METHODS

We retrospectively identified 70 patients who engaged in high-impact sports and 140 with low activity levels from among 843 THAs from a prospectively collected database performed between September 1, 1995, and December 31, 2000. Patients were evaluated at a minimum followup of 10 years (mean, 11 years; range, 10-15 years) by two independent observers. We obtained a HHS and HOOS at each followup.

RESULTS

The mean HOOS was higher in the high-impact group for three of the five subscales of the HOOS. Mean linear wear was higher in the high-impact group than in the low-activities group. We also found a higher number of revisions in the high-activity group.

CONCLUSIONS

Our observations confirm concern about the risk of THA mechanical failures related to high-impact sport, and patient and surgeons alike should be aware of these risks of mechanical failures.

LEVEL OF EVIDENCE

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Physical activity after total joint arthroplasty

Context:

Total joint arthroplasty (TJA) is a common surgical option to treat painful degenerative joint disease. However, there is currently no consensus on the appropriate intensity of physical activity after TJA or how physical activity level affects the rate of revision surgery.

Materials and Methods:

A systematic review of the literature regarding physical or athletic activity after TJA was performed to determine current clinical opinion and recommendations regarding appropriate activity levels after TJA, as well as variables affecting successful surgery and improved outcomes.

Results:

Many studies in the literature regarding athletic activity after TJA focus on total hip arthroplasty and total knee arthroplasty. The literature reports contradictory results regarding rates of physical activity after TJA as well as the relationship between physical activity and rates of revision surgery. The current trend in expert opinion shows more liberal recommendations for patients to engage in athletic activity after TJA.

Conclusions:

Individual characteristics, lifestyle, and patient preferences must be taken into account when one considers appropriate recommendations for athletic activity after TJA. Current trends in clinical opinion favor a higher level of athletic activity after TJA, but clinicians should caution patients not to participate in contact sports or sports that create high joint loads in the replaced joint.

Patient factors predict periprosthetic fractures after revision total hip arthroplasty

We assessed important patient risk factors for postoperative periprosthetic fractures after revision total hip arthroplasty (THA) using prospectively collected Institutional Joint Registry data. We used univariate and multivariable-adjusted Cox regression analyses. There were 330 postoperative periprosthetic fractures after 6281 revision THAs. In multivariable-adjusted analyses, hazard ratio (95% confidence interval) of periprosthetic fracture was higher for women (1.66 [1.32-2.080], P < .001), a higher Deyo-Charlson comorbidity index of 2 (1.46 [1.03-2.07]) and index of 3+ (2.01 [1.48-2.73]; overall, P < .001), and operative diagnosis, especially previous nonunion (5.76 [2.55-13.02]; overall, P < .001). Hazard ratio was lower in patients 61 to 70 years old (0.64 [0.49-0.84]) and 71 to 80 years old (0.57 [0.43-0.76]) compared with those younger than 60 years (overall, P < .0001). Our study identified important modifiable and unmodifiable risk factors for fractures after revision THA.

Sport activity following joint arthroplasty: a systematic review

INTRODUCTION

Although the clinical and functional outcomes of patients undergoing knee arthroplasty have widely been investigated, there is little information on the postoperative sport activity status.

SOURCES OF DATA

We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 25 February 2011, using various combinations of the keyword terms 'Knee arthroplasty', 'Knee replacement', 'Total Knee replacement', 'Unicondylar Knee replacement', 'Knee Prosthesis', 'Sport Activity', 'Return To Sport Activity Level' and 'Recreational Sporting Level'. Twenty-two articles published in peer-reviewed journals were included in this review.

AREAS OF AGREEMENT

Patients report improved outcomes, in terms of pain, symptoms, activities of daily living, sport activity and quality of life, compared with preoperative status. Only low-impact physical activities are recommended. The Coleman Methodology Score showed great heterogeneity in the study design, patients' characteristics, management methods and outcome assessment, and generally low methodological quality.

AREAS OF CONTROVERSY

Data are too heterogeneous to allow for definitive conclusions on long-term outcomes of total knee arthroplasty. It is not possible to compare the post-operative sport activity status of the patients.

GROWING POINTS

Validated and standardized measures should be used to report outcomes of patients undergoing knee arthroplasty. Function surveys that better depict sport activities, and include actual physical function testing, should be used.

RESEARCH

There is a need to perform appropriately powered randomized clinical trials using standard diagnostic assessment, and a common and validated scoring system comparing reported outcomes and the duration of follow-up >2 years.

Activity profile of members of an online health community after articular cartilage repair of the knee

BACKGROUND

Articular cartilage repair (ACR) procedures aim to alleviate pain and restore function for individuals with chondral defects. Rehabilitation is lengthy, and there are limited data on return to sports and exercise activities after ACR in non-elite-athlete populations. The Internet is a growing source of health-related information for patients, and it has resulted in the emergence of online health communities.

PURPOSE

To establish a postoperative activity profile of users of an online health community who have undergone ACR of the knee and to compare this profile with those from the same community who have undergone initial anterior cruciate ligament reconstruction (ACLR).

STUDY DESIGN

Cross-sectional.

METHODS

Tegner Activity Scale ratings were collected via a self-reported online questionnaire from 201 participants of an online health community who had undergone tibiofemoral and/or patellofemoral ACR (n = 75) or ACLR (n = 126).

RESULTS

A higher Tegner activity level was significantly correlated to time from surgery for ACR (P < 0.005) and ACLR (P < 0.01). At a minimum of 24 months' follow-up, the ACR group had a median postoperative Tegner score of 3, compared with 6 for the ACLR group. Tegner score was significantly negatively correlated with age at time of surgery for ACLR (P < 0.05) but not for ACR. Men demonstrated significantly higher Tegner activity levels than did women for both ACLR and ACR (P < 0.05).

CONCLUSIONS

Activity levels after ACR in this population increased with postoperative time but remained lower than expected when compared with current published clinical and normative data.

CLINICAL RELEVANCE

Engagement with an online health community may influence expectations regarding return to sports and exercise activities. Reporting of activity-level data within clinical studies should be differentiated on the basis of sex. Further research is needed to elucidate factors that determine return to sports and exercise activities after ACR.

Return to golf after spine surgery

Object

No published evidence indicates when patients can resume golfing after spine surgery. The objective of this study is to provide data from surveys sent to spine surgeons.

Methods

A survey of North American Spine Society members was undertaken querying the suggested timing of return to golf. Of 1000 spine surgeons surveyed, 523 responded (52.3%). The timing of recommended return to golf and the reasons were questioned for college/professional athletes and avid and recreational golfers of both sexes. Responses were tallied for lumbar laminectomy, lumbar microdiscectomy, lumbar fusion, and anterior cervical discectomy with fusion.

Results

The most common recommended time for return to golf was 4–8 weeks after lumbar laminectomy and lumbar microdiscectomy, 2–3 months after anterior cervical fusion, and 6 months after lumbar fusion. The results showed a statistically significant increase in the recommended time to resume golf after lumbar fusion than after cervical fusion in all patients (p < 0.01). The same holds true for the return to play after cervical fusion compared with either lumbar laminectomy or lumbar microdiscectomy for all golfer types (p < 0.01). There was a statistically significant shorter recommended time for professional and college golfers compared with noncompetitive golfers after lumbar fusion (p < 0.01), anterior cervical discectomy and fusion (p < 0.01), and lumbar microdiscectomy (p < 0.01).

Conclusions

The return to golf after spine surgery depends on many variables, including the general well-being of patients in terms of pain control and comfort when golfing. This survey serves as a guide that can assist medical practitioners in telling patients the average times recommended by surgeons across North America regarding return to golf after spine surgery.

Total knee arthroplasty in motivated patients with knee osteoarthritis and athletic activity approach type goals: a conceptual decision-making model

Knee osteoarthritis is one of the most common disabling medical conditions. With longer life expectancy the number of total knee arthroplasty (TKA) procedures being performed worldwide is projected to increase dramatically. Patient education, physical activity, bodyweight levels, expectations and goals regarding the ability to continue athletic activity participation are also increasing. For the subset of motivated patients with knee osteoarthritis who have athletic activity approach type goals, early TKA may not be the best knee osteoarthritis treatment option to improve satisfaction, quality of life and outcomes. The purpose of this clinical commentary is to present a conceptual decision-making model designed to improve the knee osteoarthritis treatment intervention outcome for motivated patients with athletic activity approach type goals. The model focuses on improving knee surgeon, patient and rehabilitation clinician dialogue by rank ordering routine activities of daily living and quality of life evoking athletic activities based on knee symptom exacerbation or re-injury risk. This process should help establish realistic patient expectations and goals for a given knee osteoarthritis treatment intervention that will more likely improve self-efficacy, functional independence, satisfaction and outcomes while decreasing the failure risk associated with early TKA.

Sports activity after anatomical total shoulder arthroplasty

BACKGROUND

Implant functionality has clearly increased over the past decades because of improvements in total shoulder arthroplasty systems. This means that prostheses are now being implanted in younger patients with high sports activity.

HYPOTHESIS

The implantation of the total shoulder arthroplasty does not mainly influence the sports activity.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

One hundred consecutive patients with unilateral total shoulder arthroplasty, followed for at least 1 year, were included in the study. Assessment preoperatively and 1 year and 2 years after operation included clinical examination and a validated questionnaire (Constant, Shoulder Pain and Disability Index [SPADI], and Disabilities of the Arm, Shoulder and Hand [DASH] scores, and the Short Form 36 [SF-36]). In addition, all patients received a sports questionnaire developed in house.

RESULTS

Of the 55 patients who took part in sports before having shoulder disease, 49 (89%) were still able to participate after a mean follow-up of 2.8 years (range, 1.3-4.6 years). Seventeen patients had given up sports before total shoulder arthroplasty; 11 of them resumed activities after joint replacement but 6 did not start again. No patient had to stop sports because of the total shoulder arthroplasty. The sports most commonly mentioned were swimming (10 patients [20.4%]), golf (8 patients [16.3%]), cycling (8 patients [16.3%]), and fitness training (8 patients [16.3%]). Strength and range of motion, as well as the physical component summary (PCS) of the SF-36 and the Constant score (CS) after total shoulder arthroplasty, were significantly better in the sports group (49 of 100; PCS = 46, CS = 77) than in the nonsports group (45 of 100; PCS = 41,CS = 71). Eighteen patients (36.7%) stated that even after joint replacement, they still suffered restrictions on their sports activities because of shoulder problems. Whereas the overall mean age at follow-up was 68.9 years (range, 26-92 years), the mean age of patients participating in sports was significantly lower than in the nonsports group (63 vs 70 years; P = .002).

CONCLUSION

Total shoulder arthroplasty allows patients to participate in sports without significant restriction of their level of activity. The probability of being able to do sports postoperatively-if done preoperatively-is high. Long-term studies are needed to determine whether the greater loading on the joint will lead to more rapid wear and a higher rate of loosening with time.

Sports activity after total hip resurfacing

BACKGROUND

Little is known about sports activity after total hip resurfacing.

HYPOTHESIS

Patients undergoing total hip resurfacing can have a high level of sports activity.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

The authors evaluated the level of sports activities with a standardized questionnaire in 138 consecutive patients (152 hips) 2 years after total hip resurfacing. Range of motion, Harris hip score, and Oxford score were assessed, and radiological analysis was performed.

RESULTS

Preoperatively, 98% of all patients participated in sports activities. Two years postoperatively, 98% of the patients participated in at least 1 sports activity. The level of sports activity decreased after surgery. The number of sports activities per patient decreased from 3.6 preoperatively to 3.2 postoperatively. Intermediate- and high-impact sports, especially tennis, soccer, jogging, squash, and volleyball, showed a significant decrease while the low-impact sports (stationary cycling, Nordic walking, and fitness/weight training) showed a significant increase. Physical activity level at the time of follow-up as measured by the Grimby scale was significantly higher than in the year before surgery. Duration of sports participation per week increased significantly after surgery. Men had a significantly higher sport level than women before and after surgery. Eighty-two percent felt no restriction while performing sports. One-third missed certain sports activities such as jogging, soccer, tennis, and downhill skiing. The Harris hip and Oxford scores showed a significant increase postoperatively.

CONCLUSION

The results of this short-term follow-up study show that sports activity after total hip resurfacing surgery is still possible. Physical activity level increased with a shift toward low-impact sports. Duration of sports participation increased. High-impact sports activities decreased. These findings can be important for the decision-making process for hip surgery and should be communicated to the patient.

Atividade física e esportiva após artroplastia de quadril

A artroplastia é utilizada para reconstrução da articulação do quadril, visando minimizar a dor e possibilitar o retorno às atividades de vida diária, esportivas e de lazer. O objetivo deste artigo é analisar na literatura as indicações e contraindicações referentes à prática de atividade física, esportiva e lazer após a artroplastia de quadril. Essa revisão aborda estudos publicados entre os anos de 1980 e 2009, obtidos por buscas em bancos de dados eletrônicos Medline, Scielo, Ovid, Infomaworld, Sciencedirect, Springerlink, Interscience, Sportdiscuss, Bireme, Informglobal, Opas, Ovid, Diseasedex, Eric, que totalizaram 39 artigos. Os artigos analisados apontam para a utilização de atividade física, esportiva e de lazer de baixo impacto. como a caminhada, natação, boliche, ciclismo, dentre outras. Outra indicação constatada na literatura é a utilização da atividade física e esportiva visando à manutenção do condicionamento físico, qualidade óssea e controle do peso corporal. Há ressalvas na literatura sobre a utilização de atividades de alto impacto, esporte com giro como o basquete e futebol ou com grande intensidade como tênis e a corrida, bem como os esportes de luta. As atividades físicas, esportivas e de lazer mais indicadas após uma atroplastia de quadril são as de baixo impacto como a hidroginástica, natação, caminhada, dentre outras. O início dessas atividades deve aguardar a liberação do médico, mas em média iniciam 60 dias após a cirurgia.

Activity recommendations after total hip and knee arthroplasty: a survey of the American Association for Hip and Knee Surgeons

There are limited data to guide surgeon recommendations regarding activities after total joint arthroplasty. The present study aims to better clarify the current community standards. A questionnaire was distributed to the members of the American Association for Hip and Knee Surgeons attending the 2007 annual meeting inquiring about recommendations for 15 activities for patients with total hip arthroplasty or total knee arthroplasty. One hundred thirty-nine surveys were returned. Spearman rank correlation was used to analyze the data. More than 95% of the responses placed no limitations on low-impact activities including level surface walking, stair climbing, level surface bicycling, swimming, and golf. Higher-impact activities were more commonly discouraged, although there was considerable variability. Recommendations after total hip arthroplasty were more liberal compared to those after total knee arthroplasty. Higher-volume surgeons tended to be more liberal in their recommendations. No responder indicated that there was strong scientific evidence for their recommendations. Investigations are needed to elucidate the long-term effects of higher load and/or higher cycle activities on total joint arthroplasty.

Prevention of strain-related osteopenia in aseptic loosening of hip prostheses using perioperative bisphosphonate

The hypothesis tested in this study was that perioperative administration of the bisphosphonate zoledronate will reduce strain protection-related calcar osteopenia and maintain functional integration of the femoral component in an ovine hemiarthroplasty model. Twelve sheep received a unilateral cemented hemiarthroplasty where six animals were given nine intravenous infusions of zoledronate (10 microg/kg) pre-, peri-, and postsurgery over 8 months. Control animals received physiological saline only. Implants remained in vivo for 9 months. Ground reaction force (GRF) was used to assess functional loading of the implanted limb, bone mineral density (BMD) was quantified using dual energy X-ray absorptiometry (DEXA). Cortical bone area, thickness, and viable osteocytes were assessed histologically. No significant differences in GRF data between groups was identified. Results demonstrated a significant drop in BMD values in the control group (9.7%) when compared with the bisphosphonate-treated group (3.2%) (p = 0.0159). Histological results showed that cortical area, thickness, and the percentage of lacunae with viable osteocytes was significantly greater in the bisphosphonate-treated group when compared with control (p = 0.002, p = 0.001, p = 0.003, respectively). The administration of zoledronate reduced cortical osteopenia in the calcar region of the proximal femur and this therapy could be used as a preventive measure to combat strain protection osteopenia and its contribution to associated aseptic loosening in total hip replacement surgery.

Knee arthroplasties have similar results in high- and low-activity patients

With increased patient demand to return to active lifestyles, total knee arthroplasties have evolved from primarily providing pain relief to allowing for increased function and mobility. We evaluated the influence of activity on the outcome of total knee arthroplasties. The overall satisfaction, rate of revision, and clinical and radiographic results for high-activity patients were compared with a matched group of low-activity patients at a minimum followup of 4 years (mean, 7 years; range, 4-14 years). There were 22 men and 35 women (72 knees) in each group. High-activity patients fared as well as their low-activity counterparts with no differences in clinical outcomes. At the time of last followup, mean Knee Society objective scores were 95 points (range, 70-100 points) and 96 points (range, 80-100 points) for the high-activity and low-activity groups, respectively. The high-activity group had one clinical failure, and neither group had any revisions. The groups had similar radiographic outcomes with no progressive radiolucencies and no evidence of osteolysis. While we await long-term results, these results suggest that low- to moderate-impact sports activities had no effect on the clinical and/or radiographic outcomes of total knee arthroplasties at mid-term followup.

Total hip arthroplasties: what are the reasons for revision?

Primary total hip arthroplasties have reported success rates of greater than 95% in many series with a longer than 10-year follow-up. Revision total hip arthroplasty due to such factors as increased high-activity levels, younger patients undergoing the procedure and increasing life expectancy has become more prevalent. An understanding of the mechanisms and timing of total hip arthroplasty failure can direct efforts aimed at reducing revision rates. This study was conducted to evaluate the indications for revision hip arthroplasty and relate these to the time after the index primary hip arthroplasty. A review of all revision hip arthroplasties at two centres over a 6-year time period identified 225 patients who underwent 237 revisions. The overall mean time to revision was 83 months (range: 0-360 months). The cause of failure was aseptic loosening in 123 hips (51.9%), instability in 40 hips (16.9%) and infection in 37 hips (5.5%). When stratified into two groups (less than 5 years, more than 5 years after the index primary hip arthroplasty), 118 of 237 (50%) revisions occurred in less than 5 years, with 33% due to instability and 24% resulting from infection. The majority of the causes of failure within 5 years in these early revisions were instability and deep infection. The success of hip arthroplasty is likely to be compromized if technical aspects of the surgery for appropriate component positioning and critical protocols to minimise complications such as infection are not given the proper attention.