Objectively measured early physical activity after total hip or knee arthroplasty

Jul 25, 2018Journal of clinical monitoring and computing

Measured early physical activity after total hip or knee replacement

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Abstract

A mean reduction of 64 counts × 10/day in physical activity was observed in total hip arthroplasty patients during the first two weeks post-surgery.

A significant decline in activity levels was noted for both total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients compared to preoperative levels.
High-intensity physical activity saw the largest decrease during the postoperative period.
Approximately 30% of THA patients and 20% of TKA patients exhibited reduced and declining activity levels after surgery.
Daytime activity levels were monitored from two days before to 13 days (THA) or 20 days (TKA) after surgery.
No specific pathogenic factor was found to strongly correlate with poor recovery in physical activity.

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Although reduced early physical function after total hip- and knee arthroplasty (THA/TKA) is well-described, the underlying reasons have not been clarified with detailed studies on pathophysiological mechanisms related to recovery, thereby prohibiting advances in rehabilitation. Thus, we aimed to describe early post-THA/TKA physical activity measured by actigraphy and potential underlying pathophysiological mechanisms related to recovery in a well-defined cohort of THA and TKA patients. Daytime-activity was measured from 2 days before until 13 (THA) or 20 (TKA) days after surgery. The primary outcome was individualized recovery in activity, with secondary analyses of activity-intensities and association to the perioperative factors: sex, age, BMI, hemoglobin (hgb), C-reactive protein and postoperative pain. Eighty-one THA/TKA-patients were examined. A large inter-individual variation in early physical activity was found. On a group level, activity was significantly reduced compared to preoperatively the first 2 (THA) or 3 (TKA) weeks after surgery (mean-difference - 64 counts × 10/day, p < 0.001 and - 78 counts × 10/day, p < 0.001, respectively). All activity-intensities were affected with the largest decline in high intense activity. A slight overall improvement in activity was seen during the postoperative phase [THA: 1%/day (SD 2.15); TKA: 0.7%/day (SD 1.04)], but approximately 30% of THA and 20% of TKA patients had reduced and declining activity. Hgb, CRP, BMI (THA) and postoperative pain (TKA) were only weakly associated with impaired physical activity. Physical activity was reduced the first weeks following THA/TKA, but with large inter-individual variations in recovery profiles. No single pathogenic factor was associated with a poor recovery. Early risk stratified interventions are needed in patients on a suboptimal course. 3 3

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Objectively measured early physical activity after total hip or knee arthroplasty

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