[A novel questionnaire to assess activity in patients after hip arthroplasties]

Function and activity after minimally invasive total hip arthroplasty compared to a healthy population

PURPOSE

The aim of the present study was to compare the daily activity and functionality in a patient cohort 12 months after total hip arthroplasty (THA) using a direct anterior approach with a healthy non-operated control population.

METHODS

Sixty-four patients who underwent THA and 59 healthy individuals (control) were assessed regarding their daily activity and joint functionality utilizing the Harris hip score (HHS), the extra short musculoskeletal functional assessment questionnaire (XSFMA), the Short Form 36 (SF-36) health survey and a Stepwatch™ Activity Monitor (SAM). Post-operative x-ray images after THA were analysed regarding inclination and stem positioning.

RESULTS

Twelve months after surgery, the average HHS showed no significant difference between both groups equalling 90.7 points in the THA patient group and 90.8 in the healthy volunteer group. The XSFMA functional index scores were 11.0 (THA) and 5.0 (control) while the bother index summed up to a score of 15.3 (THA) and 7.6 (control) respectively thus differing significantly (p < 0.001). Daily activity equalled 4227 (THA) and 4687 (control) load cycles per day (p = 0.327) while a number of 5658 (THA) and 6417 (control) steps per day (p = 0.011) was recorded. The SF-36 physical component scores were 47.3 (THA) and 50.6 (control) points while the psychometric properties added up to a score of 56.1 (THA) and 55.9 (control). The physical component was determined to be significantly different (p < 0.001) whereas no statistically significant difference could be shown for the psychometric properties (p = 0.511). The radiographic analysis revealed an average cup inclination of 39.9° without signs of migration. Stem positioning was neutral in 53% of all cases while 36% were graded varus and 11% valgus.

CONCLUSION

In summary, our short-term results show an activity, functionality and quality of life for patients one year after THA comparable to healthy control individuals.

How active are patients undergoing total joint arthroplasty?: A systematic review

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.