HOW ACTIVE ARE TOTAL JOINT ARTHROPLASTY PATIENTS? A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Physical inactivity is a modifiable lifestyle-related risk factor considered one of the leading causes for the major noncommunicable chronic diseases and relates to approximately 250,000 deaths per year in the United States. While the benefits of physical activity (PA) are many and well-known, qualitative research defining the type and amount of PA in total joint arthroplasty (TJA) patients that improves health without disproportionally increasing wear and revision rates does unfortunately not exist in the literature. As the basis for future research, this systematic review therefore aimed to identify the different instruments used up to now to quantify PA in TJA patients and to determine how active these patients really are. Within the 26 studies included (n=2460 patients), motion sensors and recall questionnaires were most commonly used. The reported Results were mainly descriptive and research aims and goals varied widely between the studies. We were able to meta-analytically summarize the Results of those studies quantifying PA using pedometers and accelerometers. Patients took a weighted mean of 6,721 steps/day (95% CI: 5,744 to 7,698). Steps per day determined by accelerometers were 2.2 times more than steps assessed by pedometers. Meta-regression demonstrated that walking activity decreased by 90 steps/day (95% CI: −156 to −23) every year of patient age. These summarized Results clearly indicate that TJA patients are less active than recommended to achieve health-enhancing activity levels (currently > 10,000 steps/day), but they are more active than normally assumed in wear-simulations. Hence, such simulator Results have to be interpreted cautiously, taking into account that one million cycles correspond to less than one year in vivo. Future investigations have to evolve more standardization in the assessment and reporting of PA in TJA patients.