There could be lots of reasons a person is not more active AFTER a joint replacement. Please don’t assume a direct correlation between inactivity and joint replacement.
A systematic review published in Clinical Rehabilitation has challenged the assumption that people are more active after they have a hip replacement. This can be quite alarming to hear for those who have gone through the trauma of having a replacement, some 650,000 people a year in the UK. For them physical inactivity because of osteoarthritis is the number one reason they decide to have a replacement joint.
Unfortunately this does make for easy headlines and controversial discussion in the media and will most likely have a negative impact on elective rates of hip replacement. What of course won’t be considered is the methodological quality of the studies involved in the studies previously performed investigating physical activity and hip replacements. Overall in this systematic review the quality was generally low to moderate according to CASP criteria.
Additionally consider the largest patient groups who have hip replacements, what else could limit their activity levels? Here is a brief consideration:
- Other Msk pain / joint involvement
- Other chronic co-morbidities such a lung disease
- Follow up study times may not allow a long enough rehabilitation time for frail or pre-frail individuals
- Do people want to become more physically active than they were before operation?
- Should the studies be looking at quality of life instead of a physical measurement?
- How much pre-operative ‘prehab’ was involved?
These are just a few considerations which need to be explained to patients before a fully informed decision can be made about having an operation and allow realistic expectations afterwards.
What else do you think should be considered before jumping to conclusions?