When it comes to physical activity following total hip or total knee arthroplasty, the current standard of care is to recommend unlimited low-impact activity, according to a paper presented at the November 2008 American Association for Hip and Knee Surgeons (AAHKS) Annual Meeting.

With recent improvements in implant fixation and wear reduction, 95 percent of orthopaedic surgeons who responded to a survey say they place no limitations on swimming, golf, walking on even surfaces, bicycling on level surfaces, or climbing stairs when recommending activities for patients with a well-functioning total hip replacement (THR) or total knee replacement (TKR). Higher-impact activities are more commonly discouraged, and there is a trend towards more activity restrictions following successful TKR.

Lead investigator Eli Swanson, MD, and his coauthors reached their conclusions after distributing a questionnaire to the 657 attendees at the 2007 AAHKS meeting, asking respondents to indicate their usual recommendation on 15 different activities for patients with a well-functioning and well-fixed THR or TKR. A total of 139 surveys were returned (21 percent response rate). An ordinal logistic regression was used to calculate the odds ratio for activity recommendations.

Although nearly all respondents strongly encouraged low-impact activity, 71 percent discouraged THR patients from jogging, 83 percent advised against difficult skiing, and 49 percent said “no” to singles tennis. The responses for TKR were similar, except that 60 per­cent of physicians warned against singles tennis. Occasional (once or twice a month) doubles tennis was recommended after THR by 71 percent; the same activity after TKR was allowed by 66 percent of respondents.

None of the respondents indicated that they had strong scientific evidence for their recommendations.

Dr. Swanson and his co-researchers, Frederick Dorey, PhD, and Thomas P. Schmalzried, MD, are with the department of orthopaedic surgery at the University of California Los Angeles.

Carolyn Rogers is a staff writer for AAOS Now. She can be reached at rogers@aaos.org

Another look:
How much athletic activity following TJR is too much?

Although many patients who undergo a hip or knee replacement may wish to return to athletic activity after surgery, they should know that they may be taking a risk with their new joint, according to a new study, “Athletic Activity after Total Joint Arthroplasty,” published in the October 2008 issue of the Journal of Bone and Joint Surgery.

“Patients who choose to play sports after joint replacement should train for their sport, build up back, hip, and knee strength, and be aware of the potential risks of athletic activity after joint replacement,” the report says.

According to the latest data on athletic activity after joint replacement, patients generally reduce athletic activity after joint replacement, even though they might not want to do so.

The review—conducted by William L. Healy, MD; Sanjeev Sharma, MD; Benjamin Schwartz, MD; and Richard Iorio, MD—documents a trend for hip and knee surgeons to allow more athletic activity after joint replacement, but notes that no good evidence exists to support this trend.

“High levels of activity may compromise the durability of joint replacement and reduce implant survival,” says Dr. Healy, the lead researcher. “Implant wear has been shown to be related to how much the joint is used as opposed to the length of time the artificial joint has been in place.”

Innovations such as alternative bearing surfaces, large femoral heads, hip resurfacing, unicompartmental knee replacement, mobile-bearing knee replacement, and high-flexion knee replacement offer the potential for high-demand function with low rates of failure, but these potential benefits have not been proven, the study reports.

“We need to keep in mind that surgeons and patients often assess the success of joint replacement differently,” Dr. Healy says. “Surgeons look at pain, function, survivorship, and the need for revision surgery, while patients consider their pain and activity. If the joint allows them to play their favorite sport without pain, they may not be concerned about needing an additional surgery in the future.”