Skip to main content
SpringerLink
Log in

How Active are Patients Undergoing Total Joint Arthroplasty?: A Systematic Review

  • Survey (Systematic Review)
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Qualitative research studies regarding physical activity in patients undergoing total joint arthroplasty (TJA) unfortunately are sparse in the current literature.

Questions/Purposes

To provide a foundation for future investigations, we performed a systematic review to identify the different instruments used to quantify physical activity in patients undergoing TJA and to determine how active these patients really are.

Methods

We systematically reviewed the literature on the bibliographic databases Medline, Cochrane Library, and EMBASE published until September 2008, focusing on studies assessing total physical activity in patients after or undergoing TJA. Results of those studies quantifying physical activity using accelerometers and pedometers were combined using meta-analytic methods.

Results

In the 26 studies included (n = 2460 patients), motion sensors and recall questionnaires were most commonly used. The research aims and goals varied widely among the studies and the results mainly were descriptive. Studies quantifying physical activity using pedometers and accelerometers suggested a weighted mean of 6721 steps/day (95% confidence interval [CI], 5744–7698). Steps per day determined by accelerometers were 2.2 times the steps measured by pedometers. Metaregression showed that walking activity decreased by 90 steps/day (95% CI, −156 to −23) every year of patient age.

Conclusions

These results suggest patients undergoing TJA are less active than recommended to achieve health-enhancing activity levels (greater than 10,000 steps/day), but they appear more active than normally assumed in typical wear simulations. Future investigations have to evolve more standardization in the assessment and reporting of physical activity in TJA patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. ACSM. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30:975–991.

    Google Scholar 

  2. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. Philadelphia, PA: Lea & Febiger; 1995.

    Google Scholar 

  3. Bennett D, Humphreys L, O’Brien S, Kelly C, Orr J, Beverland DE. Activity levels and polyethylene wear of patients 10 years post hip replacement. Clin Biomech (Bristol, Avon). 2008;23:571–576.

    CAS  Google Scholar 

  4. Bennett D, Humphreys L, O’Brien S, Kelly C, Orr J, Beverland DE. The influence of wear paths produced by hip replacement patients during normal walking on wear rates. J Orthop Res. 2008;26:1210–1217.

    PubMed  Google Scholar 

  5. Blair SN, LaMonte MJ, Nichaman MZ. The evolution of physical activity recommendations: how much is enough? Am J Clin Nutr. 2004;79:913S–920S.

    CAS  PubMed  Google Scholar 

  6. Bohannon RW. Number of pedometer-assessed steps taken per day by adults: a descriptive meta-analysis. Phys Ther. 2007;87:1642–1650.

    PubMed  Google Scholar 

  7. Booth FW, Gordon SE, Carlson CJ, Hamilton MT. Waging war on modern chronic diseases: primary prevention through exercise biology. J Appl Physiol. 2000;88:774–787.

    CAS  PubMed  Google Scholar 

  8. Brandes M, Schomaker R, Mollenhoff G, Rosenbaum D. Quantity versus quality of gait and quality of life in patients with osteoarthritis. Gait Posture. 2008;28:74–79.

    PubMed  Google Scholar 

  9. Caspersen CJ. Physical activity epidemiology: concepts, methods, and applications to exercise science. Exerc Sport Sci Rev. 1989;17:423–473.

    CAS  PubMed  Google Scholar 

  10. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–131.

    CAS  PubMed  Google Scholar 

  11. Cavill N, Kahlmeier S, Racioppi F. Physical Activity and Health in Europe: Evidence for Action. Geneva, Switzerland: World Health Organization; 2006.

    Google Scholar 

  12. Church TS, Earnest CP, Skinner JS, Blair SN. Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure: a randomized controlled trial. JAMA. 2007;297:2081–2091.

    CAS  PubMed  Google Scholar 

  13. Cukras Z, Praczko K, Kostka T, Jegier A. Physical activity of elderly patients after total hip arthroplasty. Orthop Traumatol Rehabil. 2007;9:286–296.

    Google Scholar 

  14. Davey Smith G, Egger M. Meta-analysis: unresolved issues and future developments. BMJ. 1998;316:221–225.

    CAS  PubMed  Google Scholar 

  15. Davey Smith G, Egger M, Phillips AN. Meta-analysis: beyond the grand mean? BMJ. 1997;315:1610–1614.

    CAS  PubMed  Google Scholar 

  16. de Groot IB, Bussmann HJ, Stam HJ, Verhaar JA. Small increase of actual physical activity 6 months after total hip or knee arthroplasty. Clin Orthop Relat Res. 2008;466:2201–2208.

    PubMed  Google Scholar 

  17. de Groot IB, Bussmann JB, Stam HJ, Verhaar JAN. Actual everyday physical activity in patients with end-stage hip or knee osteoarthritis compared with healthy controls. Osteoarthritis Cartilage. 2008;16:436–442.

    PubMed  Google Scholar 

  18. Dorey FJ, Amstutz HC. The need to account for patient activity when evaluating the results of total hip arthroplasty with survivorship analysis. J Bone Joint Surg Am. 2002;84:709–710.

    PubMed  Google Scholar 

  19. Egger M, Schneider M, Davey Smith G. Spurious precision? Meta-analysis of observational studies. BMJ. 1998;316:140–144.

    CAS  PubMed  Google Scholar 

  20. Egger M, Smith GD. Meta-analysis: potentials and promise. BMJ. 1997;315:1371–1374.

    CAS  PubMed  Google Scholar 

  21. Egger M, Smith GD. Bias in location and selection of studies. BMJ. 1998;316:61–66.

    CAS  PubMed  Google Scholar 

  22. Fagard RH, Cornelissen VA. Effect of exercise on blood pressure control in hypertensive patients. Eur J Cardiovasc Prev Rehabil. 2007;14:12–17.

    PubMed  Google Scholar 

  23. Feller JA, Kay PR, Hodgkinson JP, Wroblewski BM. Activity and socket wear in the Charnley low-friction arthroplasty. J Arthroplasty. 1994;9:341–345.

    CAS  PubMed  Google Scholar 

  24. Fleg JL, Morrell CH, Bos AG, Brant LJ, Talbot LA, Wright JG, Lakatta EG. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation. 2005;112:674–682.

    PubMed  Google Scholar 

  25. Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Meyer HE. The effect of middle-age body weight and physical activity on the risk of early revision hip arthroplasty: a cohort study of 1535 individuals. Acta Orthop. 2007;78:99–107.

    PubMed  Google Scholar 

  26. Fontaine KR, Heo M, Bathon J. Are US adults with arthritis meeting public health recommendations for physical activity? Arthritis Rheum. 2004;50:624–628.

    PubMed  Google Scholar 

  27. Gartland JJ. Orthopaedic clinical research: Deficiencies in experimental design and determinations of outcome. J Bone Joint Surg Am. 1988;70:1357–1364.

    CAS  PubMed  Google Scholar 

  28. Goldsmith AA, Dowson D, Wroblewski BM, Siney PD, Fleming physical activity, Lane JM. The effect of activity levels of total hip arthroplasty patients on socket penetration. J Arthroplasty. 2001;16:620–627.

    CAS  PubMed  Google Scholar 

  29. Goldsmith AA, Dowson D, Wroblewski BM, Siney PD, Fleming physical activity, Lane JM, Stone MH, Walker R. Comparative study of the activity of total hip arthroplasty patients and normal subjects. J Arthroplasty. 2001;16:613–619.

    CAS  PubMed  Google Scholar 

  30. Gschwend N, Frei T, Morscher E, Nigg B, Loehr J. Alpine and cross-country skiing after total hip replacement: 2 cohorts of 50 patients each, one active, the other inactive in skiing, followed for 5–10 years. Acta Orthop Scand. 2000;71:243–249.

    CAS  PubMed  Google Scholar 

  31. Hamer M, Chida Y. Walking and primary prevention: a meta-analysis of prospective cohort studies. Br J Sports Med. 2008;42:238–243.

    CAS  PubMed  Google Scholar 

  32. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39:1423–1434.

    PubMed  Google Scholar 

  33. Healy WL, Sharma S, Schwartz B, Iorio R. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. 2008;90:2245–2252.

    PubMed  Google Scholar 

  34. Heisel C, Silva M, dela Rosa MA, Schmalzried TP. Short-term in vivo wear of cross-linked polyethylene. J Bone Joint Surg Am. 2004;86:748–751.

    PubMed  Google Scholar 

  35. Heisel C, Streich N, Krachler M, Jakubowitz E, Kretzer JP. Characterization of the running-in period in total hip resurfacing arthroplasty: an in vivo and in vitro metal ion analysis. J Bone Joint Surg Am. 2008;90(suppl 3):125–133.

    PubMed  Google Scholar 

  36. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.

    PubMed  Google Scholar 

  37. Iwane M, Arita M, Tomimoto S, Satani O, Matsumoto M, Miyashita K, Nishio I. Walking 10,000 steps/day or more reduces blood pressure and sympathetic nerve activity in mild essential hypertension. Hypertens Res. 2000;23:573–580.

    CAS  PubMed  Google Scholar 

  38. Jones DL, Cauley JA, Kriska AM, Wisniewski SR, Irrgang JJ, Heck DA, Kwoh CK, Crossett LS. Physical activity and risk of revision total knee arthroplasty in individuals with knee osteoarthritis: a matched case-control study. J Rheumatol. 2004;31:1384–1390.

    PubMed  Google Scholar 

  39. Kruger J, Carlson SA, Buchner D. How active are older Americans? Prev Chronic Dis. 2007;4:A53.

    PubMed  Google Scholar 

  40. Lamonte MJ, Ainsworth BE. Quantifying energy expenditure and physical activity in the context of dose response. Med Sci Sports Exerc. 2001;33(suppl):S370–S378; discussion S419–S420.

    Google Scholar 

  41. Le Masurier GC, Lee SM, Tudor-Locke C. Motion sensor accuracy under controlled and free-living conditions. Med Sci Sports Exerc. 2004;36:905–910.

    PubMed  Google Scholar 

  42. Le Masurier GC, Tudor-Locke C. Comparison of pedometer and accelerometer accuracy under controlled conditions. Med Sci Sports Exerc. 2003;35:867–871.

    PubMed  Google Scholar 

  43. Lee IM, Skerrett PJ. Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports Exerc. 2001;33(suppl):S459–S471; discussion S493–S494.

    Google Scholar 

  44. Leon AS, Connett J, Jacobs DR Jr, Rauramaa R. Leisure-time physical activity levels and risk of coronary heart disease and death. The Multiple Risk Factor Intervention Trial. JAMA. 1987;258:2388–2395.

    CAS  PubMed  Google Scholar 

  45. Macera CA, Ham SA, Yore MM, Jones DA, Ainsworth BE, Kimsey CD, Kohl HW III. Prevalence of physical activity in the United States: Behavioral Risk Factor Surveillance System, 2001. Prev Chronic Dis. 2005;2:A17.

    PubMed  Google Scholar 

  46. Madsen MS, Ritter MA, Morris HH, Meding JB, Berend ME, Faris PM, Vardaxis VG. The effect of total hip arthroplasty surgical approach on gait. J Orthop Res. 2004;22:44–50.

    PubMed  Google Scholar 

  47. McClung CD, Zahiri CA, Higa JK, Amstutz HC, Schmalzried TP. Relationship between body mass index and activity in hip or knee arthroplasty patients. J Orthop Res. 2000;18:35–39.

    CAS  PubMed  Google Scholar 

  48. Mudd LM, Rafferty AP, Reeves MJ, Pivarnik JM. Physical activity recommendations: an alternative approach using energy expenditure. Med Sci Sports Exerc. 2008;40:1757–1763.

    PubMed  Google Scholar 

  49. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346:793–801.

    PubMed  Google Scholar 

  50. Naal FD, Fischer M, Preuss A, Goldhahn J, von Knoch F, Preiss S, Munzinger U, Drobny T. Return to sports and recreational activity after unicompartmental knee arthroplasty. Am J Sports Med. 2007;35:1688–1695.

    PubMed  Google Scholar 

  51. 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.

    PubMed  Google Scholar 

  52. Naal FD, Maffiuletti NA, Munzinger U, Hersche O. Sports after hip resurfacing arthroplasty. Am J Sports Med. 2007;35:705–711.

    PubMed  Google Scholar 

  53. Nocon M, Hiemann T, Muller-Riemenschneider F, Thalau F, Roll S, Willich SN. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil. 2008;15:239–246.

    PubMed  Google Scholar 

  54. Ono R, Hirata S, Yamada M, Nishiyama T, Kurosaka M, Tamura Y. Reliability and validity of the Baecke physical activity questionnaire in adult women with hip disorders. BMC Musculoskelet Disord. 2007;8:61.

    PubMed  Google Scholar 

  55. Orendurff MS, Schoen JA, Bernatz GC, Segal AD, Klute GK. How humans walk: bout duration, steps per bout, and rest duration. J Rehabil Res Dev. 2008;45:1077–1089.

    PubMed  Google Scholar 

  56. Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med. 1986;314:605–613.

    PubMed  Google Scholar 

  57. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402–407.

    CAS  PubMed  Google Scholar 

  58. Pescatello LS, Blanchard BE, Van Heest JL, Maresh CM, Gordish-Dressman H, Thompson PD. The metabolic syndrome and the immediate antihypertensive effects of aerobic exercise: a randomized control design. BMC Cardiovasc Disord. 2008;8:12.

    PubMed  Google Scholar 

  59. Schmalzried TP, Shepherd EF, Dorey FJ, Jackson WO, dela Rosa M, Fa’vae F, McKellop HA, McClung CD, Martell J, Moreland JR, Amstutz HC. The John Charnley Award. Wear is a function of use, not time. Clin Orthop Relat Res. 2000;381:36–46.

    PubMed  Google Scholar 

  60. Schmalzried TP, Szuszczewicz ES, Northfield MR, Akizuki KH, Frankel RE, Belcher G, Amstutz HC. Quantitative assessment of walking activity after total hip or knee replacement. J Bone Joint Surg Am. 1998;80:54–59.

    CAS  PubMed  Google Scholar 

  61. Schneider PL, Bassett DR Jr, Thompson DL, Pronk NP, Bielak KM. Effects of a 10,000 steps per day goal in overweight adults. Am J Health Promot. 2006;21:85–89.

    PubMed  Google Scholar 

  62. Sechriest VF II, 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.

    PubMed  Google Scholar 

  63. Silva M, McClung CD, Dela Rosa MA, Dorey FJ, Schmalzried TP. Activity sampling in the assessment of patients with total joint arthroplasty. J Arthroplasty. 2005;20:487–491.

    PubMed  Google Scholar 

  64. Silva M, Shepherd EF, Jackson WO, Dorey FJ, Schmalzried TP. Average patient walking activity approaches 2 million cycles per year: pedometers under-record walking activity. J Arthroplasty. 2002;17:693–697.

    PubMed  Google Scholar 

  65. Sofi F, Capalbo A, Cesari F, Abbate R, Gensini GF. Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil. 2008;15:247–257.

    PubMed  Google Scholar 

  66. Talis VL, Grishin AA, Solopova IA, Oskanyan TL, Belenky VE, Ivanenko YP. Asymmetric leg loading during sit-to-stand, walking and quiet standing in patients after unilateral total hip replacement surgery. Clin Biomech (Bristol, Avon). 2008;23:424–433.

    Google Scholar 

  67. Thompson D, Batterham AM, Markovitch D, Dixon NC, Lund AJ, Walhin JP. Confusion and conflict in assessing the physical activity status of middle-aged men. PLoS ONE. 2009;4:e4337.

    PubMed  Google Scholar 

  68. Tudor-Locke C, Ainsworth BE, Thompson RW, Matthews CE. Comparison of pedometer and accelerometer measures of free-living physical activity. Med Sci Sports Exerc. 2002;34:2045–2051.

    PubMed  Google Scholar 

  69. Tudor-Locke C, Hatano Y, Pangrazi RP, Kang M. Revisiting ‘how many steps are enough?’ Med Sci Sports Exerc. 2008;40(suppl):S537–S543.

    Google Scholar 

  70. Tudor-Locke C, Sisson SB, Lee SM, Craig CL, Plotnikoff RC, Bauman A. Evaluation of quality of commercial pedometers. Can J Public Health. 2006;97(suppl 1):S10–S16.

    PubMed  Google Scholar 

  71. US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Sudbury, MA: Jones and Bartlett Publishers; 1999.

  72. Wagenmakers R, Stevens M, van den Akker-Scheek I, Zijlstra W, Groothoff JW. Predictive value of the Western Ontario and McMaster Universities Osteoarthritis Index for the amount of physical activity after total hip arthroplasty. Phys Ther. 2008;88:211–218.

    PubMed  Google Scholar 

  73. Wagenmakers R, Stevens M, Zijlstra W, Jacobs ML, van den Akker-Scheek I, Groothoff JW, Bulstra SK. Habitual physical activity behavior of patients after primary total hip arthroplasty. Phys Ther. 2008;88:1039–1048.

    PubMed  Google Scholar 

  74. Walker DJ, Heslop PS, Chandler C, Pinder IM. Measured ambulation and self-reported health status following total joint replacement for the osteoarthritic knee. Rheumatology. 2002;41:755–758.

    CAS  PubMed  Google Scholar 

  75. Wallbridge N, Dowson D. The walking activity of patients with artificial hip joints. Eng Med. 1982;11:95–96.

    CAS  PubMed  Google Scholar 

  76. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006;174:801–809.

    PubMed  Google Scholar 

  77. Warburton DE, Nicol CW, Bredin SS. Prescribing exercise as preventive therapy. CMAJ. 2006;174:961–974.

    PubMed  Google Scholar 

  78. Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN. Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med. 2000;132:605–611.

    CAS  PubMed  Google Scholar 

  79. Wei M, Kampert JB, Barlow CE, Nichaman MZ, Gibbons LW, Paffenbarger RS Jr, Blair SN. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA. 1999;282:1547–1553.

    CAS  PubMed  Google Scholar 

  80. Whitehead A. Meta-analysis of Controlled Clinical Trials. Chichester, United Kingdom: Wiley & Sons; 2002.

    Google Scholar 

  81. Wollmerstedt N, Noth U, Mahlmeister F, Lotze A, Finn A, Eulert J, Hendrich C. [A novel questionnaire to assess activity in patients after hip arthroplasties] [in German]. Orthopade. 2006;35:1237–1245.

    CAS  PubMed  Google Scholar 

  82. Wright RW, Brand RA, Dunn W, Spindler KP. How to write a systematic review. Clin Orthop Relat Res. 2007;455:23–29.

    PubMed  Google Scholar 

  83. Wylde V, Blom A, Dieppe P, Hewlett S, Learmonth I. Return to sport after joint replacement. J Bone Joint Surg Br. 2008;90:920–923.

    CAS  PubMed  Google Scholar 

  84. Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Spital Netz Bern–Ziegler, Morillonstrasse 75, 3007, Berne, Switzerland

    Florian D. Naal MD

  2. Department of Research and Development, Schulthess Clinic, Zurich, Switzerland

    Florian D. Naal MD & Franco M. Impellizzeri PhD

Authors
  1. Florian D. Naal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Franco M. Impellizzeri PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Florian D. Naal MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

This work was performed at the Schulthess Clinic, Zurich, Switzerland.

Appendix

Appendix

Appendix Suggestions for future research projects and proposal regarding how data should be assessed and reported
Full size table

About this article

Cite this article

Naal, F.D., Impellizzeri, F.M. How Active are Patients Undergoing Total Joint Arthroplasty?: A Systematic Review. Clin Orthop Relat Res 468, 1891–1904 (2010). https://doi.org/10.1007/s11999-009-1135-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-009-1135-9

Keywords

Search

Navigation