Preoperative Physical Activity Level Has No Relationship to the Degree of Recovery One Year after Primary Total Hip or Knee Arthroplasty: A Cohort Study

PLOS ONE, Dec 2019

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-coefficient = 0.03, CI95% = −0.033–0.093) and leisure-time physical activity level (B-coefficient = 0.042, CI95% = −0.009–0.093) neither for preoperative compliance with the Dutch Recommendation for Health-Enhancing Physical Activity (B-coefficient = 0.002, CI95% = −0.053–0.057), 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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0115559&type=printable

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. - 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)


This is a preview of a remote PDF: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0115559&type=printable

Sietske Poortinga, Inge van den Akker-Scheek, Sjoerd K. Bulstra, Roy E. Stewart, Martin Stevens. Preoperative Physical Activity Level Has No Relationship to the Degree of Recovery One Year after Primary Total Hip or Knee Arthroplasty: A Cohort Study, PLOS ONE, 2014, Volume 9, Issue 12, DOI: 10.1371/journal.pone.0115559