Published online Feb 18, 2019. doi: 10.5312/wjo.v10.i2.90
Peer-review started: November 10, 2018
First decision: December 7, 2018
Revised: January 22, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 18, 2019
Lower limb arthroplasty is being performed in increasing numbers worldwide on progressively younger patients with few medical co-morbidities. Currently, patients who have stopped participating in athletic activity secondary to their degenerative joint disease may wish to consider returning to their chosen athletic activities. It is not presently clear as to why patients who undergo successful joint arthroplasty do not always return to athletic activity, either under any circumstance or in a different capacity to pre-operatively.
The issues surrounding returning to athletic activity following either hip or knee replacement are explored in this study, specifically the factors behind patients’ failure to return to participation in athletic activity post-operatively. Patient expectations being met are key in satisfaction following joint arthroplasty and having information on their ability to perform athletic activity post-operatively is significant information to present the patient with pre-operatively to allow them to make informed choices.
The main objective for this study was to examine the rate of return to athletic activity post lower limb arthroplasty and determine the qualitative reasons for any failure to return to athletic activity. These objectives were met as part of the study, demonstrating that questionnaire studies of this type can deliver qualitative responses as well as quantitative scores, from which meaningful conclusions can be drawn.
This was a single centre, single surgeon retrospective questionnaire study with descriptive statistical analysis performed to interpret the results; these methods are frequently employed in questionnaire studies of this nature.
This study demonstrated that patients can return to athletic activity following joint replacement to a satisfactory level. Reasons for non-participation in athletic activity include (in equal proportions) the patient not wanting to stress their joint replacement or instruction from either the lead surgeon or other doctor/health professional. Hip and knee replacements had similar outcomes and return to athletic activity rates. Problems remaining to be solved are the lack of explicit links between athletic activity and accelerated implant loosening; should such a link be established, it will affect the advice provided by health care professionals regarding the suitability of performing athletic activity post joint replacement.
The study found there are multiple factors behind a failure to return to athletic activity, including a patient wish to preserve their joint, instructions from the operating surgeon and instructions from another health care professional, including physiotherapists and general practitioners. There is no one single reason why people, with no other co-morbidities or painful joints, do not return to full athletic activity. People who are athletically active before joint replacement have a desire to return to activity post-operatively and are able to do so to a satisfactory level, with no significant differences between hip and knee replacements. The study offers original insight in that there are now qualitative reasons behind a failure to return to normal athletic activity. Future hypotheses that could be tested are that, given the vast ability of patients to perform activity to a high level post-operatively, restrictions on activity may be unnecessary and potentially relaxed given the ability of patients in this study. In addition to a prospective study investigating the conclusions further, a consensus piece could be developed to provide information to patients, surgeons and allied health professionals about suitable athletic activities post joint arthroplasty, based both on recent evidence but not neglecting the experience of the surgeons. The variety of qualitative reasons for non-participation in athletic activities represents a new area in this field. This study confirmed that patients are satisfied with their athletic capabilities following joint arthroplasty. This study may influence the decision making for patients wishing to undergo arthroplasty but also wanting to return to sport
This study demonstrated that qualitative research has a role in outcome data alongside validated outcome questionnaires. Future research should involve prospective studies with 10-15 year outcomes. The methodology should include validated outcome questionnaires for athletic activity alongside radiographic analysis to assess for implant loosening and assess implant survival in athletically active populations post arthroplasty.