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Chapple C1, Browne O1, Gillespie C1, Henderson S1, Hill N1
1University of Otago, School of Physiotherapy, Dunedin, New Zealand
Background: Total joint arthroplasty (TJA) is a common, effective intervention for end stage lower limb osteoarthritis (OA). Sporting activities are often curtailed due to OA, and return to sport (RTS) can be an aspirational goal of patients undergoing surgery. Recent research has investigated alpine skiing after total knee arthroplasty, but how realistic is this for most patients? As physiotherapists what advice can we give patients about RTS following TJA? Our research questions were: What sports are safe to participate in? How soon can patients RTS? What are the likely adverse events?
Purpose: The purpose of this study was to conduct a systematic review about RTS for patients undergoing TJA of the lower limb. Physiotherapists will be able to use this information for patient education.
Methods: PRISMA guidelines informed the conduct of this review. Multiple databases were searched for observational studies including participants who had undergone TJA for osteoarthritis, and returned to some form of sport or recreational activity such as walking. Outcomes were the type of sports patients returned to, time taken to RTS, and reports of related adverse events. Abstract and full-text screening, data extraction and assessment of bias were performed by two independent reviewers. Heterogeneity of studies precluded a meta-analysis. Overall level of evidence was reported using a framework described by Lievense et al (2002).
Results: Eleven studies were included in the review, 10 with low risk of bias. Four studies involved hip arthroplasty, 7 studies knee arthroplasty; sample size ranged from 11-830; follow-up was 12 months to 11 years, with 2 studies longer than 10 years.
Moderate level of evidence from 11 studies supported return to low/moderate impact sports including golf (8 studies); and from 4 studies supported return to high impact sport.
It took on average 17 weeks to RTS, ranging from 6.9 weeks for aqua aerobics to 13.1 weeks for swimming. Low number of studies meant level of evidence was limited.
Moderate level of evidence showed pain was a common adverse effect during and after sport participation post TJA.
Conflicting evidence from 2 long-term studies reported on prostheses loosening attributed to sports participation.
Conclusion(s): Low impact activities such as golf, bowls, swimming and cycling are deemed safe following TJA. Moderate impact activities such as dancing and hiking are most likely safe while high impact activities such as running, tennis, snow-skiing and water-skiing remain controversial and long-term consequences unclear. Four months can be used as a guide for time to return to low-impact sport, although this recommendation needs to be tailored to individual patient responses. A common adverse effect of return to sport is pain. More research is required to investigate long-term effects of sports participation on prosthesis longevity.
Implications: Physiotherapists are well-placed to educate patients about RTS following TJA.
Evidence suggests low and moderate impact sports are safe to return to from about 4 months post-surgery.
Participation in high impact sport is possible but long-term consequences are unclear.
Patients should be warned about the possibility of pain during and after sports.
Keywords: Total joint arthroplasty, Sports participation
Funding acknowledgements: No funding was required for this review
Purpose: The purpose of this study was to conduct a systematic review about RTS for patients undergoing TJA of the lower limb. Physiotherapists will be able to use this information for patient education.
Methods: PRISMA guidelines informed the conduct of this review. Multiple databases were searched for observational studies including participants who had undergone TJA for osteoarthritis, and returned to some form of sport or recreational activity such as walking. Outcomes were the type of sports patients returned to, time taken to RTS, and reports of related adverse events. Abstract and full-text screening, data extraction and assessment of bias were performed by two independent reviewers. Heterogeneity of studies precluded a meta-analysis. Overall level of evidence was reported using a framework described by Lievense et al (2002).
Results: Eleven studies were included in the review, 10 with low risk of bias. Four studies involved hip arthroplasty, 7 studies knee arthroplasty; sample size ranged from 11-830; follow-up was 12 months to 11 years, with 2 studies longer than 10 years.
Moderate level of evidence from 11 studies supported return to low/moderate impact sports including golf (8 studies); and from 4 studies supported return to high impact sport.
It took on average 17 weeks to RTS, ranging from 6.9 weeks for aqua aerobics to 13.1 weeks for swimming. Low number of studies meant level of evidence was limited.
Moderate level of evidence showed pain was a common adverse effect during and after sport participation post TJA.
Conflicting evidence from 2 long-term studies reported on prostheses loosening attributed to sports participation.
Conclusion(s): Low impact activities such as golf, bowls, swimming and cycling are deemed safe following TJA. Moderate impact activities such as dancing and hiking are most likely safe while high impact activities such as running, tennis, snow-skiing and water-skiing remain controversial and long-term consequences unclear. Four months can be used as a guide for time to return to low-impact sport, although this recommendation needs to be tailored to individual patient responses. A common adverse effect of return to sport is pain. More research is required to investigate long-term effects of sports participation on prosthesis longevity.
Implications: Physiotherapists are well-placed to educate patients about RTS following TJA.
Evidence suggests low and moderate impact sports are safe to return to from about 4 months post-surgery.
Participation in high impact sport is possible but long-term consequences are unclear.
Patients should be warned about the possibility of pain during and after sports.
Keywords: Total joint arthroplasty, Sports participation
Funding acknowledgements: No funding was required for this review
Topic: Orthopaedics; Musculoskeletal: lower limb
Ethics approval required: No
Institution: University of Otago
Ethics committee: School of Physiotherapy
Reason not required: This was a systematic review of literature
All authors, affiliations and abstracts have been published as submitted.
