Most Patients Sedentary After Total Hip Arthroplasty

While total hip arthroplasty significantly reduces a patient’s pain and improves their ability to walk, most of the patients remain sedentary afterwards, a new study finds.

The study, “Changes in 24-Hour Physical Activity Patterns and Walking Gait Biomechanics After Primary Total Hip Arthroplasty,” was published online in The Journal of Bone & Joint Surgery on May 27, 2021.

Jasvir S. Bahl, BAppSc, Ph.D., of the University of South Australia, Adelaide and his colleagues at the University of Adelaide, Flinders University and the Royal Adelaide Hospital, wrote that their data “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.”

In the prospective study of 51 patients who had received primary total hip arthroplasty at a single public hospital in South Australia, all the patients reported improvements in pain and other hip-related symptoms, hip function and quality of life. However, 24-hour activity monitoring showed that there was little to no change in daily physical activity.

The average age of the patients was 66 years. All the total hip arthroplasties were performed using the same surgical technique and implant type. Patient-reported outcomes on symptoms, function and quality of life were recorded prior to surgery.

These outcomes were also measured at one and two years postoperatively. Patients were also asked to undergo gait analysis and musculoskeletal modeling and 24-hour physical activity monitoring via a wrist-worn accelerometer.

Overall, the patients were asleep or sedentary for almost 20 hours a day on average, both before and after the surgery. This was found across the board, regardless of age, body mass index or occupation.

The researchers noted that for some patients, their sedentary time actually increased after total hip arthroplasty. The percentage of patients who were sedentary for more than 11 hours a day actually increased from 25 % preoperatively to 31% at one year and 41% at two years postoperatively.

Sleep quality or effectiveness on the other hand declined after surgery, despite most of the patients still getting an average of nine hours a night.

“Evidently, a surgical procedure alone may not enable patients to lead a more physically active lifestyle,” Dr. Bahl and co-authors explained.

While the underlying reasons for this continued lack of activity is unclear, they said that previous studies have suggested that it is because low activity patterns may become “hard-wired” after years of physical disability.

Increasing physical activity is important for these patients though, they said, especially for those who also suffer from health conditions like high blood pressure, obesity, and diabetes.

“Health-care providers must consider a multifaceted model of care, which includes patient education on the importance of reducing sedentary behaviors and addressing a range of barriers and facilitators to increase physical activity postoperatively,” the researchers wrote.