Summary Despite notable improvements in self-reported pain, perceived functional capacity, and gait function after primary total hip arthroplasty (THA), it is unclear whether these improvements translate to improved physical activity and sleep behaviors. The objective of this study was to determine the change in 24-hour activity profile (wake and sleep activities) and laboratory-based gait function from preoperative to 2 years post-THA. Methods: Fifty-one patients undergoing primary THA at a single public hospital were recruited. All THAs were performed through a posterior surgical approach with the same type of prosthesis. A wrist accelerometer was used to capture activity profiles for 24 hours preoperatively and at 1 and 2 years postoperatively. Three-dimensional gait analysis was performed to determine changes in temporospatial and kinematic parameters of the hip and pelvis. Results: Patients showed improvements in all temporospatial and kinematic parameters over time. Preoperatively, patients were sedentary or asleep for a mean time (and standard deviation) of 19.5 ± 2.2 hours per day. This remained unchanged until 2 years postoperatively (19.6 ± 1.3 hours per day). Sleep efficiency remained suboptimal (<85%) at all time points and was worse at 2 years (77% ± 10%) compared with preoperatively (84% ± 5%). More than a quarter of the sample were sedentary for >11 hours per day per year (32%) and 2 years (41%), which was higher than the preoperative percentage (21%). Patients accumulated their activity by doing light activities; however, patients performed less light activity at 2 years compared to preoperative levels. No significant differences (p = 0.935) were observed for moderate or vigorous activity over time. Conclusions: Along with improvements in self-reported pain and perceived physical function, patients significantly improved gait function postoperatively. However, despite the opportunity for patients to be more physically active postoperatively, patients were more sedentary, slept worse, and engaged in less physical activity at 2 years compared to preoperative levels. |
Comments
Patients who undergo total hip arthroplasty (THA) show a significant reduction in pain and other symptoms and an improvement in gait biomechanics. However, those improvements do not lead to increased levels of daily physical activity, a study reports in The Journal of Bone & Joint Surgery .
The findings "present a worrying picture that while patients have the opportunity to be more physically active through improvements in functional capacity, their physical behaviors do not change ," according to the new research, led by Jasvir S. Bahl of the University of South Australia. , Adelaide, in collaboration with the University of Adelaide, Flinders University and the Royal Adelaide Hospital. The researchers call for additional efforts to help patients achieve a healthy level of physical activity after THA.
Almost all patients remain sedentary after THA
The prospective study included 51 patients with a mean age of 66 years who underwent primary THA at a public hospital in South Australia. All procedures were performed with the same surgical technique and type of implant. Before the procedure, data were recorded for several patient-reported domains, including hip-related symptoms, function, and quality of life.
Additionally, patients underwent gait analysis and musculoskeletal modeling for an in-depth analysis of biomechanics and overall gait performance. They also completed 24-hour physical activity monitoring with the use of a wrist-based activity tracker (accelerometer).
In a subgroup of patients, gait analysis and activity monitoring were repeated one and two years postoperatively.
At both follow-up periods, patients reported improvements in pain and other hip-related symptoms, hip function, and daily quality of life. Gait analysis showed improvement in almost all aspects of gait biomechanics, including step speed and length.
However, 24-hour activity tracking showed little or no change in daily physical activity patterns.
Both before and after surgery, patients were sedentary or asleep for 19.5 hours a day, on average. This finding remained significant after adjusting for age, body mass index, and occupation.
In fact, there was evidence that sedentary time increased after THA. The percentage of patients who were sedentary for more than 11 hours per day increased from 25 percent preoperatively to 31 percent at one year and 41 percent two years postoperatively. At all assessment points, patients reported that most of their active time was spent in light physical activity.
Activity monitoring also provided information about the patient’s sleep time and quality. Average sleep time stayed the same, at about nine hours a night. However, sleep efficiency decreased year over year, from 84 percent before the operation to 80 percent at one year and to 77 percent at two years after the operation, with less than 85 percent considered sleep. ineffective.
Consistent with many previous studies, these results show that THA leads to "significant and substantial" improvements in pain, function, and quality of life. However, the present study shows that despite these improvements, few patients change their daily physical activity patterns in the two years after THA.
“Clearly, a surgical procedure alone may not allow patients to lead a more physically active lifestyle,” Dr. Bahl and his co-authors write. Although the study cannot draw conclusions about the reasons physical activity did not improve, previous reports have suggested that patterns of low activity may become "hardwired" after years of physical disability.
The authors also suggest that if patients have to wait several years before THA, they can become accustomed to a more sedentary lifestyle.
Dr. Bahl and his colleagues note that patients who undergo hip replacement surgery often have associated health conditions, such as high blood pressure, obesity, and diabetes, that are better controlled with increased physical activity and exercise. The researchers conclude: "Health care providers should consider a multifaceted model of care, including patient education about the importance of reducing sedentary behaviors and addressing a number of barriers and facilitators to increasing physical activity postoperatively."
