Primary THA Has Long-Term Effect on Physical Activity

Lasting positive outcomes seen in large patient cohort

Jennie McKee

Primary total hip arthroplasty (THA) substantially and durably improved physical activity levels in men and women in all age categories,” stated Anne Lubbeke-Wolff, MD, DSc, of the division of orthopaedics and trauma surgery at Geneva University Hospitals in Geneva, Switzerland. She presented the results of research on trends in patient physical activity before and after primary THA yesterday.

In the study, patients showed significantly improved levels of physical activity 5 years after surgery and maintained those activity levels at 10 years after surgery. Furthermore, the proportion of patients with active lifestyles before and after undergoing primary THA increased by about 10 percent in the last decade.

Prospective study
This study analyzed a prospective, hospital-based cohort of all patients who underwent THA at the researchers’ institution. They identified 3,772 patients (4,477 hips) who had surgery between March 1996 and November 2012. The mean age of patients at time of surgery was 68 years, and 56 percent were female.

The investigators obtained data on pain and function levels (as self-reported by patients) at 5 years and 10 years after surgery. In addition, patients’ physical activity levels were evaluated with the UCLA Activity Scale.

“To determine physical activity evolution over the course of osteoarthritis and THA, cross-sectional analyses were performed to assess mean UCLA scores over the following periods: prior to disease, prior to surgery, and at 5 years and 10 years after surgery,” explained Dr. Lubbeke-Wolff. In addition, the researchers performed separate analyses based on sex, age, body mass index (BMI), and American College of Anesthesiology (ASA) score categories.

Finally, they used cross-sectional analyses to evaluate secular trends in patient lifestyle (active or sedentary) during three periods (2000–2003, 2004–2007, and 2008–2012).

Analyzing the results
Among the 4,477 THAs performed, researchers obtained lifestyle information (active or sedentary) preoperatively for 2,995 THAs (2,526 patients) and at 5 years after surgery for 1,308 THAs (1,044 patients). The UCLA score was assessed preoperatively for 203 THAs (181 patients), at 5 years for 1,085 THAs (872 patients), and at 10 years for 757 THAs (599 patients).

Patients’ mean UCLA scores prior to onset of osteoarthritis (OA) symptoms were 6.9; the mean score dropped to 3.5 before undergoing THA, but rose to 5.7 at 5 and to 5.5 at 10 years after surgery.

“Compared to the level prior to the onset of symptoms, the activity level prior to surgery was decreased substantially,” noted Dr. Lubbeke-Wolff. “In patients who were 55 years or older, the level of activity after surgery almost reached the level prior to symptom onset; however, in those younger than 55 years, the level remained lower than prior to symptom onset.” She emphasized that activity levels were almost similar at 5 years and 10 years after surgery.

Dr. Lubbeke-Wolff noted that the proportion of patients who reported an active lifestyle before surgery increased from 33 percent in 2000–2003 to 47 percent in 2007–2012. However, the percentage of patients who reported a sedentary lifestyle 5 years after surgery also increased—from 50 percent for patients who underwent THA in 2000–2003, to 62 percent for patients who underwent their surgeries in 2004–2007. She noted that activity levels were lower in female patients than male patients at all times.

“Our findings reveal a large beneficial effect of primary THA on physical activity levels at 5 years and 10 years after surgery, for women and men of all ages,” concluded Dr. Lubbeke-Wolff. “In addition, this study confirms that predictors of increased activity identified at 1 year after surgery are still as predictive at 5 years after surgery.”

Dr. Lubbeke-Wolff’s coauthors for Scientific Paper 044, “Trends in Patient Physical Activity Before and After Primary Total Hip Arthroplasty” include Dorith Zimmermann, DSc; Constantinos Roussos, MD; Alexis Bonvin, MD; Robin E. Peter, MD; Pierre J. Hoffmeyer, MD.

Disclosure information: Drs. Lubbeke-Wolff, Roussos, and Bonvin, and Ms. Zimmermann—no conflicts. Prof. Peter—Stryker; Sanofi-Aventis; Norvartis; Roche; Swiss Orthopaedic Society; AO. Prof. Hoffmeyer—DePuy, A Johnson & Johnson Company; Zimmer; Synthes; Medacta; Journal of Bone and Joint Surgery–British; AO Foundation; European Federation of National Societies of Orthopaedics and Traumatology.

2013 Annual Meeting News
Tuesday through Friday, February 19 – 23, 2013.
http://www.aaos.org/news/acadnews/2013/AAOS5_3_20.asp