Preoperative Physical Activity Level Has No Relationship to the Degree of Recovery One Year after Primary Total Hip or Knee Arthroplasty: A Cohort Study
December
Preoperative Physical Activity Level Has No Relationship to the Degree of Recovery One Year after Primary Total Hip or Knee Arthroplasty: A Cohort Study
Sietske Poortinga 0 2
Inge van den Akker-Scheek 0 2
Sjoerd K. Bulstra 0 2
Roy E. Stewart 1 2
Martin Stevens * 0 2
0 Department of Orthopaedics, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands,
1 Department of Health Sciences, Community and Occupational Sciences, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
2 Editor: Franc ois Hug, The University of Queensland , Australia
Background: When it comes to prevalidation, it is assumed that a higher preoperative level of physical activity leads to better postoperative recovery. However current literature is inconclusive about the effect of prevalidation on functional recovery of patients with primary osteoarthritis (OA) who underwent a THA or TKA. Therefore the aim of this study is to analyse one of the major assumptions underlying the potential effectiveness of prevalidation namely the relationship between preoperative physical activity level and postoperative recovery one year after THA or TKA in a group of 658 OA patients. Methods and Results: From 2006 to 2012, 1061 patients underwent a primary THA or TKA at University Medical Center Groningen. Preoperative and one-year postoperative patients filled in the SQUASH questionnaire to get an impression of their physical activity level, and the WOMAC questionnaire to obtain insight into degree of recovery. Missing data were multiply imputed. No relationship was found between the preoperative total (B-coefficient50.03, CI95%520.033-0.093) and leisure-time physical activity level (B-coefficient50.042, CI95%520.009-0.093) neither for preoperative compliance with the Dutch Recommendation for HealthEnhancing Physical Activity (B-coefficient50.002, CI95%520.053-0.057), and the degree of recovery one year after surgery. Conclusion: The preoperative physical activity level had no relation with the degree of recovery one year after THA or TKA. The results do not support one of the major assumptions behind prevalidation, which assumes that a higher preoperative physical activity level will lead to a better recovery after THA or TKA.
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Based on the Dutch GP registries, osteoarthritis (OA) is the most common
progressive disorder of the musculoskeletal system [1, 2]. In the Netherlands, the
prevalence of OA of the hip was 29.1 per 1,000 people and the prevalence of OA of
the knee was 38.1 per 1,000 people [1, 2]. Total hip and total knee arthroplasty
(THA and TKA, respectively) are both successful and cost-effective interventions
in end-stage OA [3].
It is hypothesized that the amount of preoperative physical activity and thus the
fitness level can have a positive effect on the postoperative recovery of patients
undergoing THA or TKA. This assumption is based on the fact that physical
activity, fitness and health are mutually influencing factors [4]. From these
interrelationships it is hypothesized that preoperative exercise aimed at improving
physical activity and fitness level what is known as prevalidation can be
effective in improving postoperative recovery. Prevalidation is being introduced
more and more in the treatment of THA and TKA patients with OA. Several
Australian hospitals have already introduced preoperative physiotherapy
programs for patients with OA who are on a waiting list for a joint replacement [5].
However, current literature is inconclusive about the effect of prevalidation. The
most recent systematic review by Hoogeboom et al. [6] concluded that it remains
unconfirmed whether prevalidation affects functional recovery after THA or TKA.
Objective of this study is to analyze one of the major assumptions underlying
the potential effectiveness of prevalidation namely that the amount of
preoperative physical activity and consequently the fitness level has a positive
effect on the postoperative recovery of patients undergoing THA or TKA. Insight
into this relationship can strengthen or weaken the arguments for using
prevalidation as a tool to improve postoperative recovery. The main question in
this research is: Is there a connection between preoperative physical activity level
and degree of recovery one year after THA or TKA in patients with OA?
This research question is divided into three sub-questions:
1) Is there a connection between the preoperative total physical activity level and the degree of recovery one year after THA or TKA?
2) Is there a connection between the preoperative level of leisure-time physical
activity and the degree of recovery one year after THA or TKA?
3) Is there a connection between preoperatively meeting the Dutch Recommendation for Health-Enhancing Physical Activity and the degree of recovery one year after THA or TKA?
A retrospective cohort study of prospectively collected data was conducted.
Patients were asked to fill in (...truncated)