Clinical Orthopaedics and Related Research®

, Volume 470, Issue 2, pp 555–561 | Cite as

Predictors of Participation in Sports After Hip and Knee Arthroplasty

  • Daniel H. Williams
  • Nelson V. Greidanus
  • Bassam A. Masri
  • Clive P. Duncan
  • Donald S. GarbuzEmail author
Symposium: Papers Presented at the Annual Meetings of The Hip Society



While the primary objective of joint arthroplasty is to improve patient quality of life, pain, and function, younger active patients often demand a return to higher function that includes sporting activity. Knowledge of rates and predictors of return to sports will help inform expectations in patients anticipating return to sports after joint arthroplasty.


We measured the rate of sports participation at 1 year using the UCLA activity score and explored 11 variables, including choice of procedure/prosthesis, that might predict return to a high level of sporting activity, when controlling for potential confounding variables.


We retrospectively evaluated 736 patients who underwent primary metal-on-polyethylene THA, metal-on-metal THA, hip resurfacing arthroplasty, revision THA, primary TKA, unicompartmental knee arthroplasty, and revision TKA between May 2005 and June 2007. We obtained UCLA activity scores on all patients; we defined high activity as a UCLA score of 7 or more. We evaluated patient demographics (age, sex, BMI, comorbidity), quality of life (WOMAC score, Oxford Hip Score, SF-12 score), and surgeon- and procedural/implant-specific variables to identify factors associated with postoperative activity score. Minimum followup was 11 months (mean, 12.1 months; range, 11–13 months).


Preoperative UCLA activity score, age, male sex, and BMI predicted high activity scores. The type of operation and implant characteristics did not predict return to high activity sports.


Our data suggest patient-specific factors predict postoperative activity rather than factors specific to type of surgery, implant, or surgeon factors.

Level of Evidence

Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.


Unicompartmental Knee Arthroplasty Joint Arthroplasty UCLA Score Improve Patient Quality UCLA Activity Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Daphné Savoy for her assistance in the preparation of this manuscript and Eric Sayre, PhD, for his assistance with the statistical analysis.


  1. 1.
    Amstutz HC, Beaulé PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA. Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. 2004;86:28–39.PubMedGoogle Scholar
  2. 2.
    Amstutz HC, Campbell P, McKellop H, Schmalzreid TP, Gillespie WJ, Howie D, Jacobs J, Medley J, Merritt K. Metal on metal total hip replacement workshop consensus document. Clin Orthop Relat Res. 1996;329(suppl)S297–S303.PubMedCrossRefGoogle Scholar
  3. 3.
    Amstutz HC, Thomas BJ, Jinnah RF, Kim WF, Grogan TF, Yale C. Treatment of primary osteoarthritis of the hip: a comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg Am. 1984;66:228–241.PubMedGoogle Scholar
  4. 4.
    Back DL, Dalziel R, Young D, Shimmin A. Early results of primary Birmingham hip resurfacings: an independent prospective study of the first 230 hips. J Bone Joint Surg Br. 2005;87:324–329.PubMedCrossRefGoogle Scholar
  5. 5.
    Bauman S, Williams DF, Petruccelli DF, Elliott WF, de Beer J. Physical activity after total joint replacement: a cross-sectional survey. Clin J Sport Med. 2007;17:104–108.PubMedCrossRefGoogle Scholar
  6. 6.
    Beaulé PE, Dorey FJ, Hoke RF, Leduff MF, Amstutz HC. The value of patient activity level in the outcome of total hip arthroplasty. J Arthroplasty. 2006;21:547–552.PubMedCrossRefGoogle Scholar
  7. 7.
    Beaulé PE, Dorey FJ, LeDuff M, Gruen T, Amstutz HC. Risk factors affecting outcome of metal-on-metal surface arthroplasty of the hip. Clin Orthop Relat Res. 2004;418:87–93.PubMedCrossRefGoogle Scholar
  8. 8.
    Bellamy NF, Buchanan WW, Goldsmith CH, Campbell JF, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.PubMedGoogle Scholar
  9. 9.
    Bradbury NF, Borton DF, Spoo GF, Cross MJ. Participation in sports after total knee replacement. Am J Sports Med. 1998;26:530–535.PubMedGoogle Scholar
  10. 10.
    Chan FW, Bobyn JD, Medley JB, Krygier JJ, Tanzer M. The Otto Aufranc Award. Wear and lubrication of metal-on-metal hip implants. Clin Orthop Relat Res. 1999;369:10–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Chan FW, Bobyn JD, Medley JB, Krygier JJ, Yue S, Tanzer M. Engineering issues and wear performance of metal on metal hip implants. Clin Orthop Relat Res. 1996;333:96–107.PubMedCrossRefGoogle Scholar
  12. 12.
    Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br. 1972;54:61–76.PubMedGoogle Scholar
  13. 13.
    Chatterji U, Ashworth MJ, Lewis PL, Dobson PJ. Effect of total hip arthroplasty on recreational and sporting activity. ANZ J Surg. 2004;74:446–449.PubMedCrossRefGoogle Scholar
  14. 14.
    Cleveland WS, Devlin SJ, Grosse E. Regression by local fitting. J Econometrics. 1988;37:87–114.CrossRefGoogle Scholar
  15. 15.
    Corten K, Bourne RB, Charron KD, Au K, Rorabeck CH. What works best, a cemented or cementless primary total hip arthroplasty? Minimum 17-year followup of a randomized controlled trial. Clin Orthop Relat Res. 2011;469:209–217.PubMedCrossRefGoogle Scholar
  16. 16.
    Dahm DL, Barnes SA, Harrington JR, Sayeed SA, Berry DJ. Patient-reported activity level after total knee arthroplasty. J Arthroplasty. 2008;23:401–407.PubMedCrossRefGoogle Scholar
  17. 17.
    Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br. 2004;86:177–184.PubMedCrossRefGoogle Scholar
  18. 18.
    Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br. 1996;78:185–190.PubMedGoogle Scholar
  19. 19.
    Delaunay CP. Metal-on-metal bearings in cementless primary total hip arthroplasty. J Arthroplasty. 2004;19:35–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Dorr LD, Wan Z, Longjohn DB, Dubois B, Murken R. Total hip arthroplasty with use of the Metasul metal-on-metal articulation: four to seven-year results. J Bone Joint Surg Am. 2000;82:789–798.PubMedGoogle Scholar
  21. 21.
    Dumbleton JH, Manley MT. Metal-on-metal total hip replacement: what does the literature say? J Arthroplasty. 2005;20:174–188.PubMedCrossRefGoogle Scholar
  22. 22.
    Eswaramoorthy V, Moonot P, Kalairajah Y, Biant LC, Field RE. The Metasul metal-on-metal articulation in primary total hip replacement: clinical and radiological results at ten years. J Bone Joint Surg Br. 2008;90:1278–1283.PubMedCrossRefGoogle Scholar
  23. 23.
    Fisher N, Agarwal M, Reuben SF, Johnson DS, Turner PG. Sporting and physical activity following Oxford medial unicompartmental knee arthroplasty. Knee. 2006;13:296–300.PubMedCrossRefGoogle Scholar
  24. 24.
    Grubl A, Marker M, Brodner W, Giurea A, Heinze G, Meisinger V, Zehetgruber H, Kotz R. Long-term follow-up of metal-on-metal total hip replacement. J Orthop Res. 2007;25:841–848.PubMedCrossRefGoogle Scholar
  25. 25.
    Huch KF, Muller KA, Sturmer TF, Brenner HF, Puhl WF, Gunther KP. Sports activities 5 years after total knee or hip arthroplasty: the Ulm Osteoarthritis Study. Ann Rheum Dis. 2005;64:1715–1720.PubMedCrossRefGoogle Scholar
  26. 26.
    Jacobsson SA, Djerf K, Wahlstrom O. Twenty-year results of McKee-Farrar versus Charnley prosthesis. Clin Orthop Relat Res. 1996;329(suppl):S60–S68.PubMedCrossRefGoogle Scholar
  27. 27.
    Long WT, Dorr LD, Gendelman V. An American experience with metal-on-metal total hip arthroplasties: a 7-year follow-up study. J Arthroplasty. 2004;19:29–34.PubMedGoogle Scholar
  28. 28.
    McKellop H, Park SH, Chiesa RF, Doorn PF, Lu BF, Normand PF, Grigoris P, Amstutz H. In vivo wear of three types of metal on metal hip prostheses during two decades of use. Clin Orthop Relat Res. 1996;329(suppl):S128–S140.PubMedCrossRefGoogle Scholar
  29. 29.
    Mont MA, Marker DR, Seyler TM, Jones LC, Kolisek FR, Hungerford DS. High-impact sports after total knee arthroplasty. J Arthroplasty. 2008;23:80–84.PubMedCrossRefGoogle Scholar
  30. 30.
    Naal FD, Fischer MF, Preuss AF, Goldhahn JF, von Knoch FF, Preiss S, Munzinger U, Drobny T. Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med. 2007;35:1688–1695.PubMedCrossRefGoogle Scholar
  31. 31.
    Naal FD, Impellizzeri FM, Leunig M. Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res. 2009;467:958–965.PubMedCrossRefGoogle Scholar
  32. 32.
    Naal FD, Maffiuletti NA, Munzinger UF, Hersche O. Sports after hip resurfacing arthroplasty. Am J Sports Med. 2007;35:705–711.PubMedCrossRefGoogle Scholar
  33. 33.
    Rieker CB, Schon RF, Kottig P. Development and validation of a second-generation metal-on-metal bearing: laboratory studies and analysis of retrievals. J Arthroplasty. 2004;19:5–11.PubMedGoogle Scholar
  34. 34.
    Rorabeck CH, Bourne RB, Lewis PL, Nott L. The Miller-Galante knee prosthesis for the treatment of osteoarthrosis: a comparison of the results of partial fixation with cement and fixation without any cement. J Bone Joint Surg Am. 1993;75:402–408.PubMedGoogle Scholar
  35. 35.
    Rorabeck CH, Bourne RB, Mulliken BD, Nayak N, Laupacis A, Tugwell P, Feeney D. The Nicolas Andry Award. Comparative results of cemented and cementless total hip arthroplasty. Clin Orthop Relat Res. 1996;325:330–344.PubMedCrossRefGoogle Scholar
  36. 36.
    Schmidt M, Weber H, Schon R. Cobalt chromium molybdenum metal combination for modular hip prostheses. Clin Orthop Relat Res. 1996;329(suppl):S35–S47.PubMedCrossRefGoogle Scholar
  37. 37.
    Scott SC, Goldberg MS, Mayo NE. Statistical assessment of ordinal outcomes in comparative studies. J Clin Epidemiol. 1997;50:45–55.PubMedCrossRefGoogle Scholar
  38. 38.
    Sechriest VF, Kyle RF, Marek DJ, Spates JD, Saleh KJ, Kuskowski M. Activity level in young patients with primary total hip arthroplasty: a 5-year minimum follow-up. J Arthroplasty. 2007;22:39–47.PubMedCrossRefGoogle Scholar
  39. 39.
    Sharma S, Vassan U, Bhamra MS. Metal-on-metal total hip joint replacement: a minimum follow-up of five years. Hip Int. 2007;17:70–77.PubMedGoogle Scholar
  40. 40.
    Sieber HP, Rieker CB, Kottig P. Analysis of 118 second-generation metal-on-metal retrieved hip implants. J Bone Joint Surg Br. 1999;81:46–50.PubMedCrossRefGoogle Scholar
  41. 41.
    Steffen RT, Pandit HP, Palan J, Beard DJ, Gundle R, McLardy-Smith P, Murray DW, Gill HS. The five-year results of the Birmingham Hip Resurfacing arthroplasty: an independent series. J Bone Joint Surg Br. 2008;90:436–441.PubMedCrossRefGoogle Scholar
  42. 42.
    Treacy RB, McBryde CW, Pynsent PB. Birmingham hip resurfacing arthroplasty: a minimum follow-up of five years. J Bone Joint Surg Br. 2005;87:167–170.PubMedCrossRefGoogle Scholar
  43. 43.
    Wagner M, Wagner H. Medium-term results of a modern metal-on-metal system in total hip replacement. Clin Orthop Relat Res. 2000;379:123–133.PubMedCrossRefGoogle Scholar
  44. 44.
    Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483.PubMedCrossRefGoogle Scholar
  45. 45.
    Wylde VF, Blom AF, Dieppe PF, Hewlett S, Learmonth I. Return to sport after joint replacement. J Bone Joint Surg Br. 2008;90:920–923.PubMedCrossRefGoogle Scholar
  46. 46.
    Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Daniel H. Williams
    • 1
  • Nelson V. Greidanus
    • 1
  • Bassam A. Masri
    • 1
  • Clive P. Duncan
    • 1
  • Donald S. Garbuz
    • 1
    Email author
  1. 1.Division of Lower Limb Reconstruction and Oncology, Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada

Personalised recommendations