Background/Purpose:  Total joint replacement surgery has become one of the most common elective surgical procedures. Improvements in pain and physical function following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are known however less is known about changes in physical activity (PA). A recent systematic review qualitatively described changes in PA following THA and TKA but did not examine changes in pain, quality of life, and physical function. As such, the purpose of this study is to conduct a systematic review of the literature, with meta-analysis, on the change in PA after THA or TKA surgery and evaluate other factors such as changes in pain levels, physical function and quality of life that may contribute to participation in PA.

Methods:  We searched three databases (Pubmed, CINAHL and Embase) for peer-reviewed, English-language cohort studies that tracked change in accelerometer measured PA in the same population from pre- to-post surgery. Two reviewers independently screened titles, abstracts, and full-texts with a third reviewer settling disagreements. Two reviewers independently abstracted demographic and outcome data relating to PA, pain, physical function and quality of life. Random-effects models were used to produce standardized mean differences (SMD) for physical activity, quality of life, pain, and physical function outcomes. Effect sizes were gauged as small (SMD=0.2), moderate (SMD=0.5) and large (SMD=0.8). Heterogeneity was measured with I².

Results:  Eleven studies (531 total patients) published between 2002-2014 met eligibility criteria. Subjects mean ages ranged from 42.1 to 69.0 years of age, mean body mass index ranged from 23.0 to 32.6, and a majority of participants were women. Surgical area (TKA or THA) varied with THA alone (n=4 studies), TKA alone (n=5 studies), and combined either THA and TKA patients (n=2 studies). At 6 months post-surgery no significant increase in accelerometer measured PA was found when compared to pre-surgery PA (SMD=0.09; 95% CI -0.08 to 0.25; I²=0%). A small-to-moderate significant effect was found for accelerometer measured PA at 12 months post-surgery when compared to pre-surgery PA (SMD=0.43; 95% CI 0.22 to 0.64; I²=0%). At 6-monts post surgery large and significant effects were found for reduction in pain (SMD= -1.25 ((95% CI -1.89, -0.61)), improved quality of life (SMD=0.71 ((95% CI 0.08, 1.34)), and improved physical function (SMD=0.84 ((95% CI 0.21, 1.47)).

Conclusion:  Despite large improvements in pain, physical function and quality of life, participants PA levels remained the same at 6 months and showed modest improvement at 12 months post TKA or THA. Reasons for the decreased levels of PA are unknown but may be behavioral in nature. Considering the consistency of effect demonstrated across these eleven studies future studies should seek to understand the barriers for decreased PA following TKA or THA so that future intervention studies may improve PA among this subgroup of patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/does-physical-activity-change-after-total-hip-or-knee-arthroplasty-a-systematic-review-and-meta-analysis/