Eight out of ten patients return to a sports level equal to their pre-symptomatic level after total hip arthroplasty. A return to high-impact sports activities is less likely but is definitely possible in experienced patients. |
Overall, seven out of ten patients return to work after total hip arthroplasty. However, modern-day studies showed a mean return to work of 86%. This might be attributed to the increase in total hip arthroplasty in patients aged < 65 years as well as more liberal work recommendations. |
Preoperative sports participation and lower age are predictive of a successful return to sports. Preoperative sick leave and a high workload are predictive of no return to work. |
1 Introduction
2 Methods
2.1 Search Strategy
2.2 Eligibility Criteria and Study Selection
2.3 Outcome Measures
2.4 Data Extraction
2.5 Quality Assessment
2.6 Pooling Data
3 Results
3.1 Literature Search
3.2 Study Characteristics
Study | Study design | Study populationa | Operation type (+ fixation implant) | Rehabilitation protocol |
---|---|---|---|---|
Abe et al. [29] 2014; Japan; level of evidence: III | Case–control; follow-up: 4.8 y (range 2.3–7.8) | 608 pts with OA (85 M [14%], 523 F [86%]) Age: 62 y (range 26–98) BMI: 23.2 (range 14.7–34.2) Co: NR | Primary THA: Cemented 107; uncemented 420 | Full weight bearing as tolerated from first postop day Sports participation allowed at 6 mo postop (except contact sports) |
Arbuthnot et al. [30] 2007; UK; level of evidence: III | Retrospective; follow-up: 7.6 y (range 2.0–20.0) | 66 pts with OA who played golf pre-op (sex NR) Age: 70.4 BMI NR Co NR | Primary THA (not otherwise specified) | NR |
Atkinson et al. [42] 2010; UK; level of evidence: I | Non-randomized controlled; follow-up: 2.8 y (range 1.0–5.0) | 39 pts with bilateral hip OA Group 1: Single-episode bilateral THR (n = 18) (11 M [61%], 7 F [39%] Age: 61.9 BMI and Co NR Group 2: Staged bilateral THR (interval 44 wks [16–88]); n = 21 (13 M [62%], 8 F [38%]) Age: 63.7 BMI and Co NR | Uncemented THA (anterolateral approach) | NR |
Berger et al. [43]; 2004; USA; level of evidence: II | Prospective; follow-up: 0.3 y | 100 pts aged 40–75 y of age without previous hip surgery, BMI < 35 (74 M [74%], 26 F [26%]) Age: 56 (range 41–75) BMI: M 26.8 (range 22.5–33.0); F 24.1 (range 20.6–29.1) Co NR | Uncemented THA (minimally invasive two-incision approach) with rapid rehabilitation protocol | Preop pt education meeting Weight bearing as tolerated postop Start activities as soon as tolerated Outpatient physical therapy |
Bohm [44] 2010; Canada; level of evidence: II | Prospective; follow-up: 1.0 y | 46 pts who had undergone THA and were working preop RTW: n = 40 (21 M [53%], 19 F [47%]) Age: 49.9 BMI and Co NR No RTW: n = 6 (1 M [17%], 5 F [83%]) Age: 60.3 BMI and Co NR | Primary THA (not otherwise specified) | NR |
Chatterji et al. [31] 2004; Australia; level of evidence: III | Retrospective; follow-up: 1.0–2.0 y | 216 pts who had undergone THA 1–2 y before the study Age: 67.8 ± 10.2 Sex, BMI, and Co NR | Primary THA (cemented, uncemented, and hybrid) | Postop physiotherapy until hospital discharge No outpatient physiotherapy treatment |
Clyde et al. [45] 2013; USA; level of evidence: III | Retrospective cohort; follow-up: 5.2 y (range 1.4–10.4) | 43 pts aged ≥ 18 y receiving workers’ compensation at time of THA Primary THA: n = 43 (31 M [72%], 12 F [39%]) Age: 55.0 (range 53.5–56.4) BMI: 31.7 (range 30.6–32.8) Co NR | Primary THA (not otherwise specified) | NR |
Danielsson [46] 1965; Sweden; level of evidence: II | Prospective; follow-up: 3.5 y (range 1.0–7.0) | 30 pts who underwent THA (10 M [33%], 20 F [67%]) Age: 59 (range 32–76) BMI and Co NR | Primary THA (not otherwise specified) | Physiotherapy for 2.5 wks after operation Start increasing weight bearing after 4 wks |
Del Piccolo et al. [40] 2016; Italy; level of evidence: III | Retrospective; follow-up: Conventional stem: 4.4 y (range 1.3–6.0); short stem: 4.5 y (range 1.3–5.7) | 78 pts aged 18–50 y with OA Conventional stem: n = 58c Age: 38.7 (range 18.0–49.0) Sex, BMI and Co NR Short stem: n = 20 Age: 39.9 (range 22.0–49.0) Sex, BMI and Co NR | Primary uncemented THA: standard stem 58; short femoral stem 20 | Mobilize on day 2 postop Full weight bearing with crutches from wk 4 Crutches for 6–8 wks Low-impact activities from wk 6 postop |
Dubs et al. [28] 1983; Switzerland; level of evidence: III | Retrospective cohort; follow-up: 5.8 y (1.0–14.0) | 110 M pts (mostly aged ≤ 60) with hip OA Age: 55.4 (range 29.0–68.0) BMI and Co NR | Cemented THA | NR |
Hara et al. [32] 2017; Japan; level of evidence: III | Retrospective; follow-up: 5.7 y (range 1.0–16.6) | 524 pts with primary OA or secondary OA due to acetabular dysplasia (84 M [16%], 440 F [84%]) Age: 62.9 (range 22.0–86.0) BMI: 22.9 (± 3.3) Co NR | Uncemented THA (posterolateral approach) | Full weight bearing as tolerated with crutches or walker for 3–4 wks Progress to walking without ambulatory aids when pain free |
Huch et al. [33] 2005; Germany; level of evidence: II | Prospective cohort; follow-up: 5.0 y | 420 pts aged < 76 y with advanced OA (199 M [48%], 221 F [52%]) Age: 60.5 ± 9.7 BM: < 25: 126 (30%); 25 to < 30: 200 (48%); ≥ 30: 94 (22%) Co: diabetes, 31 (7%); hypertension, 190 (45%); gout, 44 (11%) | Primary THA (not otherwise specified) | NR |
Innmann et al. [34] 2016; Germany; level of evidence: III | Retrospective cohort; follow-up: 11.0 y (range 10.0–12.0) | 86 pts aged < 61 y, who had undergone primary uncemented THA (53 M [62%], 33 F [38%] Age: 63 (range 40–72) BMI: 27 (range 18–39) Co NR | Primary uncemented THA | NR |
Johnsson and Persson [47] 1986; Sweden; level of evidence: III | Retrospective; follow-up: 2.0 y | 118 pts aged < 60 y with OA (76 M [64%], 42 F [36%]) Age: 54 (range 36–59) BMI and Co NR | Primary cemented THA | NR |
Karampinas et al. [35] 2017; Greece; level of evidence: IV | Retrospective; follow-up: 2 y | Pts aged < 65 y with OA BFH group: n = 16 (11 M [69%], 5 F [31%]) Age: range 52–70 BMI and Co NR SMF group: n = 18 (11 M [61%], 7 F [39%]) Age: range 52–70 BMI and Co NR | Uncemented THA (posterior approach): BFH, SMF | Partial weight bearing allowed on postop day 2 Progress to full weight bearing as tolerated Use of crutches for 4 wks |
Kleim et al. [12] 2015; UK; level of evidence: IV | Cross-sectional; follow-up: 1.8 ± 0.9 y | 52 pts aged < 60 y with OA (23 M [44%], 29 F [56%]) Age: 52 ± 7.9 BMI and Co NR | Primary THA (not otherwise specified) | NR |
Krischak et al. [48] 2013; Germany; level of evidence: III | Retrospective cohort; follow-up: 2.0 y | 736 pts aged 18–60 y with OA (483 M [66%], 253 F [34%]) Age: 50.4 ± 6.2 (range 24.0–60.0) BMI and Co NR | Primary THA (not otherwise specified) | NR |
Lefevre et al. [36] 2013; France; level of evidence: IV | Retrospective; follow-up: 8.8 ± 7.1 y | 27 Judokas aged > 60 y with at least a black belt Age: 63 ± 7.2 Sex, BMI and Co NR | Primary THA (not otherwise specified) | NR |
Leichtenberg et al. [13] 2016; the Netherlands; level of evidence: II | Prospective observational; follow-up: 1.0 y | 67 pts aged < 65 y with OA + working preop (34 M [51%], 33 F [49%]) Age: 56 ± 6.6 BMI: 28 ± 6.0 Co NR | Primary THA (not otherwise specified) | NR |
Mikkelsen et al. [49] 2014; Denmark; level of evidence: I | Non-randomized controlled; follow-up: 0.1 y | 365 pts with OA undergoing THA (191 M [52%], 174 F [48%]) Age: 68.7 ± 10.0 BMI: 26.8 ± 4.5 Co NR | Primary THA (posterior approach) | Physiotherapy 1–2 times daily Home-based training program for 3 wks RG: traditional rehabilitation including movement restrictions UG: no movement restrictions |
Mobasheri et al. [50] 2006; UK; level of evidence: III | Retrospective; follow-up: 3.0 y (range 0.5–10.0) | 86 pts aged < 60 y with OA (56 M [65%], 30 F [35%]) Age: 51.4 (range 29.0–60.0) BMI and Co NR | Primary THA (not otherwise specified) | NR |
Mont et al. [39] 1999; USA; level of evidence: III | Retrospective; follow-up: 8.0 y (range 2.0–22.0) | 58 pts who were playing tennis and had undergone THA (50 M [86%], 8 F [14%]) Age: 62 (range 47–77) BMI and Co NR | Primary THA Fixation (n): Cemented 22 (29%), uncemented 48 (64%), hybrid 5 (7%) | NR |
Nevitt et al. [62] 1984; USA; level of evidence: III | Retrospective; follow-up: 4.0 y | 178 pts aged ≤ 60 y with degenerative, congenital or post-traumatic hip disorder (78 M [44%], 100 F [56%]) Age: 50 (range 21–60) BMI and Co NR | Primary THA (not otherwise specified) | NR |
Pagnano et al. [51] 2006; USA; level of evidence: II | Retrospective; follow-up: minimum 0.5 y after second THA | 26 pts with bilateral OA (10 M [38%], 16 F [62%]) Age: 69 (range 42–80) BMI and Co NR | Staged bilateral uncemented THA | Full weight-bearing as tolerated |
Peak et al. [52] 2005; USA; level of evidence: I | Randomized prospective; follow-up: 0.5 y | 265 pts undergoing primary THA (139 M [52%], 126 F [48%]) Age: 58.3 (range 14.0–88.0) BMI: RG, 29.3 (range 15.9–50.2); UG, 28.7 (range 17.6–45.7) Co NR | Uncemented THA (anterolateral approach) | Limited ROM (< 90° flexion) Full weight bearing as tolerated RG: traditional rehabilitation including full hip precautions 6 wks postop UG: no hip precautions |
Poehling-Monaghan et al. [53] 2015; USA; level of evidence: III | Retrospective cohort; follow-up: 0.7 y | Pts with OA who had not undergone previous surgery DA THA: n = 126 (59 M [46%], 67 F [53%]) Age: 64.8 ± 12.4 BMI: 30.0 ± 5.5 Co NR MP THA: n = 96 (52 M [54%], 44 F [45%]) Age: 63.9 ± 12.5 BMI: 30.5 ± 6.0 Co NR | Primary THA: DA, MP | Rapid rehabilitation protocol Seen by a physical therapist twice daily Weight bearing allowed as tolerated with gait aids |
Pons [54] 2010; Spain; level of evidence: III | Retrospective cohort; follow-up: 3.2 y (range 0.1–8.2) | 128 pts with OA (90 M [70%], 38 F [30%]) Age: 57 (range 22–76) BMI and Co NR | Primary uncemented collum femoris preserving THA (posterolateral approach) | Immediate partial weight bearing Full weight bearing 3 wks postop |
Pop et al. [61] 2016; Poland; level of evidence: IV | Retrospective; follow-up: 10.0 y | 32 pts aged < 65 y at follow-up who underwent THA between 2003 and 2005 and did not experience postop complications (18 M [56%], 14 F [44%]) Age: 58 (range 39–65) BMI NR (38% overweight, 28% obese) Co NR | Uncemented THA (84%) | Postop rehabilitation: yes, 22; no, 10 |
Raguet et al. [41] 2015; France; level of evidence: III | Retrospective; follow-up: 8.0 y (range 1.0–19.0) | 7 pts who underwent THA and practice ultrarunning (6 M [86%], 1 F [14%]) Age: 69.9 (range 61.0–86.0) BMI: 22.4 (range 19.0–25.0) Co NR | Uncemented THA (postero-lateral approach) | NR |
Sankar et al. [55] 2013; Canada; level of evidence: II | Prospective cohort; follow-up: 1.0 y | 190 pts aged 18–85 y with OA, who were working at baseline (100 M [53%], 90 F [47%]) Age: 56.1 ± 9.9 BMI: < 30: 120 (63%); ≥ 30: 69 (36%) Co NR | Primary THA (not otherwise specified) | NR |
Schmidutz et al. [37] 2012; Germany; level of evidence: IV | Retrospective case study; follow-up: 2.7 y (range 2.0–4.2) | 68 pts aged < 65 y, undergoing THA, head-neck-shaft angle > 120° (41 M [60%], 27 F [40%] Age: 55 (range 20–73) BMI: 26 (range 18–39) Co NR | Short stem hip arthroplasty (ceramic head) | Restrictions concerning weight bearing and ROM for the first 6 wks RTS recommendations based on consensus guidelines |
Suarez et al. [56] 1996; Spain; level of evidence: IV | Retrospective case study; follow-up: unknown | 747 pts aged 18–64 y who were working preop (598 M [80%], 149 F [20%]) Age: 46.9 (range 18.0–64.0) BMI and Co NR | Primary THA (not otherwise specified) | Rehabilitation was adapted to pt and could include: Kinesiotherapy postop day 1–10: hydrotherapy, ergo therapy, physical therapy for 4–5 wks |
Suckel and Best [38] 2006; Germany; level of evidence: III | Retrospective; follow-up: 4.9 y (range 1.0–18.8) | 16 pts (22 THAs) with OA who were playing golf preop Age: 65.7 (range 58.0–78.0) Sex, BMI, and Co NR | Primary THA (18 uncemented, 3 hybrid, 1 cemented) | NR |
Tilbury et al. [57] 2015; the Netherlands; level of evidence: II | Prospective cohort; follow-up: 1.0 y | 71 pts aged < 65 y with OA who had undergone THA + were working at baseline (37 M [52%], 34 F [48%]) Age: 56.0 ± 6.6 BMI: 27.8 ± 6.0 Co NR | Primary THA (not otherwise specified) | NR |
Truszcynska et al. [58] 2013; Poland; level of evidence: III | Retrospective cohort; follow-up: 2.0 ± 1.5 y | 54 pts aged < 65 y with OA who were working preop (29 M [54%], 25 F [46%]) Age: 55.9 ± 7.4 BMI and Co NR | Primary THA (not otherwise specified) | NR |
Visuri et al. [59] 1987; Finland; level of evidence: III | Retrospective; follow-up: 4.2 y | 539 pts who had undergone THA (166 M [31%], 373 F [69%]) Age range 25–84 BMI and Co NR | Primary THA (not otherwise specified) | NR |
White [60] 1987; England; level of evidence: III | Retrospective; follow-up: 7.5 y (range 5.0–10.0) | 33 pts aged < 45 y (12 M [36%], 21 F [64%]) Age: 38 (range 24–44) BMI and Co NR | Cemented THA (posterior approach) | NR |
Study | Outcome measures | Preop (pre) activity + definition of preop | Postop activity | RTS + time to RTS | RTW + time to RTW | Confounding factors |
---|---|---|---|---|---|---|
Abe et al. [29] 2014; Japan; level of evidence: III | Sports participation (n) | 48% Time to RTS: unknown | Unknown | Adjusted for in analysis: age, sex, BMI, operation type, bearing type, femoral head size, preop jogging Mentioned, not adjusted for: short term follow-up, motivation/reasons for not jogging | ||
Jogging | 27 | 13 | ||||
UCLA score | – | 10 | ||||
Definition: pre-surgery | ||||||
Arbuthnot et al. [30] 2007; UK; level of evidence: III | Sports participation (n) | 86% Time to RTS: Return to practice: 4.1 mo (range 0–48) Return to play: 5.4 mo (range 0–60) | Unknown | Adjusted for in analysis: none Mentioned, not adjusted for: reasons for no return to golf, recall bias, surgeons’ advice | ||
Golf | 66 | 57 | ||||
Definition: pre-symptomatic and pre-surgery | ||||||
Atkinson et al. [42] 2010; UK; level of evidence: I | – | – Definition: pre-surgery | – | Unknown | Unknown | Adjusted for in analysis: age, ASA grade, bilateral THA (staged vs. single-episode) Mentioned, not adjusted for: none |
Time to RTS: Group 1: 24.8 wks; Group 2: 30.8 wks | Time to RTW: Part-time: Group 1: 13.8 wks; Group 2: 19.3 wks | |||||
Full-time: Group 1: 22.0 wks; Group 2: 35.8 wks | ||||||
Berger et al. [43]; 2004; USA; level of evidence: II | – | – Definition: pre-surgery | – | Unknown | 100% Time to RTW: 8 days (range 1–20) | Adjusted for in analysis: none Mentioned, not adjusted for: selection bias, rapid recovery protocol, approach, surgeon’s advice |
Bohm [44] 2010; Canada; level of evidence: II | – | – Definition: pre-surgery | – | Unknown | 86% 20% of pts who were not working pre-op resumed work 2% stopped working Time to RTW: unknown | Adjusted for in analysis: sex, age, collecting disability insurance, preop job satisfaction, workload, Oxford Hip Score, functional limitations, education, personal income, self-employed, job motivation Mentioned, not adjusted for: none |
Chatterji et al. [31] 2004; Australia; level of evidence: III | Sports participation (n): | 93%b RTS [% (wks until RTS)] | Unknown | Adjusted for in analysis: age, sex, preop sports participation Mentioned, not adjusted for: recall bias, physiotherapist’s advice, surgeon’s advice | ||
Overall | 188 | 196 | >100 | |||
Ice skating | 0 | 0 | – | |||
Water skiing | 0 | 0 | – | |||
Volleyball | 0 | 0 | – | |||
Sailing | 1 | 1 | 100 (?) | |||
Horse riding | 1 | 1 | 100 (14) | |||
Croquet | 2 | 0 | 0 (?) | |||
Rowing | 2 | 0 | 0 (12) | |||
Snow skiing | 4 | 1 | 25 (?) | |||
Hiking | 6 | 5 | 83 (58) | |||
Jogging | 7 | 1 | 14 (?) | |||
Gardening | 9 | 4 | 44 (9) | |||
Aqua aerobics | 17 | 32 | >100 (9) | |||
Bush walking | 20 | 20 | 100 (21) | |||
Tennis | 14 | 1 | 7 (91) | |||
Fishing | 23 | 17 | 74 (20) | |||
Cycling | 28 | 18 | 64 (28) | |||
Exercise classes | 28 | 21 | 75 (16) | |||
Bowling | 36 | 28 | 78 (21) | |||
Golf | 39 | 26 | 67 (22) | |||
Swimming | 52 | 37 | 71 (8) | |||
Exercise walking | 145 | 169 | >100 (10) | |||
Grimby scale | 3.5 ± 1.2 Definition: pre-surgery | Unknown | ||||
Clyde et al. [45] 2013; USA; level of evidence: III | Occupational category (n): | Unknown | 76% Same job 91%; change of job 9% Time to RTW primary THA: 17.3 wks (range 2.0–156.0) | Adjusted for in analysis: sex, age, BMI, follow-up period, workload Mentioned, not adjusted for: recall bias, socioeconomic status, postop complications | ||
Unemployed | 1 | 11 | ||||
Non-manual labor (little physical activity) | 14 | 13 | ||||
Moderate labor (lifting < 20 lb) | 17 | 14 | ||||
Strenuous labor (lifting 20–50 lb) | 11 Definition of preop: pre-surgery | 5 | ||||
Danielsson [46] 1965; Sweden; level of evidence: II | – | – Definition: pre-surgery | – | Unknown | 57% Previous work: 18%; light manual work: 39% Time to RTW: unknown | Adjusted for in analysis: workload Mentioned, not adjusted for: none |
Del Piccolo et al. [40] 2016; Italy; level of evidence: III | Intense sports activities (including skiing, free running, tennis and contact sports, n): | Similar RTS for light and medium level activities RTS (%) | Unknown | Adjusted for in analysis: age, BMI, follow-up, THA design Mentioned, not adjusted for: not randomized, general applicability, short follow-up | ||
Conventional stem | 19 | 8 | 40% | |||
Short stem | 9 | 4 | 44% | |||
Definition: pre-symptomatic | Time to RTS: unknown | |||||
Dubs et al. [28] 1983; Switzerland; level of evidence: III | Sports participation (n): | RTS (%) | RTW (%) 93 29 80 > 100 – Time to RTW: unknown | Adjusted for in analysis: implant loosening Mentioned, not adjusted for: sex (only M), workload, surgeon’s advice | ||
Overall | 86 | 61 | 71 | |||
Hiking/climbing | 44 | 41 | 93 | |||
Skiing | 43 | 4 | 9 | |||
Swimming | 28 | 35 | > 100 | |||
Running | 17 | 17 | 100 | |||
Ball sport | 16 | 0 | 0 | |||
Cycling | 14 | 10 | 25 | |||
Tennis | 9 | 4 | 44 | |||
Riding | 9 | 1 | 11 | |||
Light athletics | 6 | 0 | 0 | |||
Wrestling | 2 | 0 | 0 | |||
Rowing | 2 | 0 | 0 | |||
Sailing | 1 | 3 | > 100 | |||
Boxing | 1 | 0 | 0 | |||
Canoeing | 1 | 1 | 100 | |||
Workload (n) | Time to RTS: unknown | |||||
Overall | 108 | 100 | ||||
Strenuous | 24 | 7 | ||||
Medium | 41 | 33 | ||||
Light | 43 | 60 | ||||
Retired | 2 | 10 | ||||
Definition: pre-surgery | ||||||
Hara et al. [32] 2017; Japan; level of evidence: III | Sports participation (n): | > 100 RTS (%) | Unknown | Adjusted for in analysis: age, BMI, sex, preop sports participation, preop UCLA score Mentioned, not adjusted for: none | ||
Overall | 288 | 318 | > 100 | |||
Walking | 48 | 84 | > 100 | |||
Swimming | 50 | 61 | > 100 | |||
Gymnastics | 23 | 50 | > 100 | |||
Strength/muscle training | 14 | 26 | > 100 | |||
Cycling | 23 | 21 | 91 | |||
Golf | 23 | 13 | 57 | |||
Dancing | 12 | 6 | 50 | |||
Bowling | 10 | 4 | 40 | |||
Racket games | 17 | 6 | 35 | |||
Aerobics | 6 | 2 | 33 | |||
Jogging | 10 | 7 | 70 | |||
Ball games | 24 | 7 | 29 | |||
Other | 28 | 32 | > 100 | |||
UCLA score | Time to RTS: unknown | |||||
RTS, yes | 4.3 ± 2.3 | 5.7 ± 1.8 | ||||
RTS, no | 3.5 ± 2.0 | 4.1 ± 1.5 (p < 0.001) | ||||
Definition: pre-surgery | ||||||
Huch et al. [33] 2005; Germany; level of evidence: II | Sports participation (n): | Lifetime/preop | > 100 Lifetime/preop | Unknown | Adjusted for in analysis: sex, age, smoking, workload, reasons for no-RTS Mentioned, not adjusted for: BMI, surgeon’s advice, comorbidities, comparability responders and non-responders | |
Overall | 408/151 | 218 | 53/> 100 | |||
Biking | 248/42 | 181 | 73/> 100 | |||
Hiking | 227/4 | 161 | 71/> 100 | |||
Swimming | 193/38 | 151 | 78/> 100 | |||
Downhill skiing | 126/0 | 17 | 13/> 100 | |||
Gymnastics | 88/21 | 57 | 65/> 100 | |||
Cross country skiing, jogging | 71/0 | 20 | 28/> 100 | |||
Tennis | 46/4 | 10 | 22/> 100 | |||
Dancing | 25/0 | 20 | 80/> 100 | |||
Definition: lifetime and pre-surgery | ||||||
Time to RTS: unknown | ||||||
Innmann et al. [34] 2016; Germany; level of evidence: III | Sports participation (n): | RTS: | Unknown | Adjusted for in analysis: sex, age Mentioned, not adjusted for: recall bias, selection bias, lack of preop data for SF-36 questionnaire | ||
Overall | 86 | 77 | 89 | |||
Cycling | 25 | 36 | > 100 | |||
Hiking | 17 | 12 | 71 | |||
Exercise walking | 14 | 16 | > 100 | |||
Tennis | 15 | 5 | 33 | |||
Soccer | 10 | 0 | – | |||
Fitness/weight lifting | 8 | 14 | > 100 | |||
Jogging | 7 | 4 | 57 | |||
Downhill skiing | 7 | 1 | 14 | |||
Gymnastics | 6 | 15 | > 100 | |||
Cross-country skiing | 6 | 1 | 17 | |||
Swimming | 5 | 15 | > 100 | |||
Basketball/handball | 5 | 0 | – | |||
Table tennis | 4 | 1 | 25 | |||
Mountain climbing | 4 | 1 | 25 | |||
Nordic walking | 2 | 6 | > 100 | |||
Aqua-aerobics | 2 | 5 | > 100 | |||
Dancing | 2 | 3 | > 100 | |||
No sports | 20 | 18 | 90 | |||
UCLA (range) | 3.8 ± 1.6 (1–9) Definition: pre-symptomatic | 6.2 ± 1.5 (3–10) (p < 0.001) | Time to RTS: < 4 wks: 22%; 1–3 mo: 29%; 3–6 mo: 22%; > 6 mo: 6% | |||
Johnsson and Persson [47] 1986; Sweden; level of evidence: III | Type of work (n): | Unknown | 66% Time to RTW: within 2 y | Adjusted for in analysis: sex, age, sick leave, workload, bilateral THA, reason for no RTW Mentioned, not adjusted for: rehabilitation | ||
Household | 2 | 3 | ||||
Light work | 11 | 19 | ||||
Moderate work | 25 | 32 | ||||
Heavy work | 31 | 15 | ||||
Definition: 2 y preop | ||||||
Karampinas et al. [35] 2017; Greece; level of evidence: IV | Sports participation (n): | RTS: | Unknown | Adjusted for in analysis: none Mentioned, not adjusted for: type of prosthesis, pt fear of complications, surgeon’s advice | ||
BFH group | ||||||
Low impact | 8 | 8 | 100% | |||
Intermediate impact | 6 | 8 | > 100% | |||
High impact | 2 | – | 0% | |||
SMF group | ||||||
Low-impact | 8 | 10 | > 100% | |||
Intermediate impact | 7 | 5 | 71% | |||
High impact | 3 | 3 | 100% | |||
UCLA score | Time to RTS: 16.5 wks (range 12.0–26.0) | |||||
BFH group | 3.5 | 6.7 | ||||
SMF group | 3.8 | 7.9 (p = NR) | ||||
HHS score | ||||||
BFH group | 56.5 | 93.7 | ||||
SMF group | 48.5 | 94.4 (p = NS) | ||||
Definition: pre-surgery | ||||||
Kleim et al. [12] 2015; UK; level of evidence: IV | Manual requirements (n): | Unknown | 75% Time to RTW: 12 ± 5 wks Preop sick leave: 15 ± 4 wks No preop sick leave: 10 ± 1 wks | Adjusted for in analysis: workload, preop sick leave, education Mentioned, not adjusted for: time to RTW, selection bias, general applicability, motivation | ||
0 = no manual requirements | 24 | – | ||||
1 = some manual requirement | 17 | – | ||||
2 = heavy manual work | 4 | – | ||||
Definition: pre-surgery | ||||||
Krischak et al. [48] 2013; Germany; level of evidence: III |
–
|
–
Definition: pre-surgery |
–
| Unknown | 85% 83% same job 17% different job Time to RTW: unknown | Adjusted for in analysis: workload, age Mentioned, not adjusted for: THA approach |
Lefevre et al. [36] 2013; France; level of evidence: IV |
–
|
–
Definition: unknown | – | 82% Time to RTS: 3.9 mo ± 2.7 All pts stopped participating at a competitive level | Unknown | Adjusted for in analysis: age Mentioned, not adjusted for: selection bias, motivation, experience, surgeon’s advice |
Leichtenberg et al. [13] 2016; the Netherlands; level of evidence: II | Type of work (n): | Unknown | Full RTW: 79%; partial RTW: 13%; no RTW: 7%d; time to RTW: unknown | Adjusted for in analysis: type of prosthesis, sex, age, education, self-employed, preop h worked, workload, preop work adaptions, preop workers compensation, preop sick leave Mentioned, not adjusted for: recall bias, baseline HOOS | ||
Light | 41 | 33 | ||||
Medium | 14 | 10 | ||||
Heavy | 4 Definition: presurgery | 3 (p = 0.672) | ||||
Mikkelsen et al. [49] 2014; Denmark; level of evidence: I | Pts working (n) | Unknown | 45% Time to RTW: unknown | Adjusted for in analysis: rehabilitation protocol Mentioned, not adjusted for: selection bias, short inclusion and follow-up period, lack of blinding, information bias, missing data | ||
RG | 37 | 12 | ||||
UG | 54 | 29 (p = 0.045) | ||||
Definition: pre-surgery | ||||||
Mobasheri et al. [50] 2006; UK; level of evidence: III | – | – Definition: pre-surgery | – | Unknown | RTW: employed preop: 96%; unemployed preop: 43% Time to RTW: employed preop: 10.5 wks; unemployed preop: 35.0 wks | Adjusted for in analysis: reasons for no RTW, self-employment, sex, > 1 y unemployed preop Mentioned, not adjusted for: preop sick-leave |
Mont et al. [39] 1999; USA; level of evidence: III | Sports participation (n): | RTS (%) | Unknown | Adjusted for in analysis: level of play, singles vs doubles, return to competitive play, motivation Mentioned, not adjusted for: fixation, recall bias, selection bias, surgeon’s advice | ||
Tennis | 58 | 58 | 100% | |||
Definition: pre-surgery | Time to RTS: 6.7 mo (range 1.0–12.0) | |||||
Nevitt et al. [62] 1984; USA; level of evidence: III | Work status (n): | Lifetime/pre-surgery | 1 y postop/4 y postop | Unknown | RTW: 1 y postop: 68%; 4 y postop: 63% 35% limitations in physical activities; 41% limited in the kind or the amount of their work Time to RTW: unknown | Adjusted for in analysis: sex, age, diagnosis, prior hip surgery, y of THA, joint pain, uni- or bilateral THA, preop work status Mentioned, not adjusted for: timing of surgery, general unemployment rates, prosthesis type |
Working | 139/81 | 95/87 | ||||
Disabled | NR/58 | 44/52 | ||||
68% limitations in physical activities 44% limited in the kind or the amount of their work Definition: lifetime and 1 mo pre-surgery | ||||||
Pagnano et al. [51] 2006; USA; level of evidence: II | – | – Definition: pre-surgery | – | Unknown | 100% Time to RTW: mini-posterior THA: 38 days (range 14–90) Two-incision THA: 42 days (range 9–56) | Adjusted for in analysis: approach (mini-posterior vs. two-incision) Mentioned, not adjusted for: influence of the first THA, complications |
Peak et al. [52] 2005; USA; level of evidence: I | Working (n): | Unknown | RTW: RG 95%; UG 100% (p = NS) Time to RTW (wks): RG 9.5; UG 6.5 (p < 0.001) | Adjusted for in analysis: rehabilitation protocol Mentioned, not adjusted for: selection bias, approach | ||
RG | 85 | 81 | ||||
UG | 98 | 98 | ||||
Definition: pre-surgery | ||||||
Poehling-Monaghan et al. [53] 2015; USA; level of evidence: III | – | – Definition: pre-surgery | – | Unknown | RTW at 8 weeks: DA 69%; MP: 97% (p < 0.01) Time to RTW: unknown | Adjusted for in analysis: THA approach Mentioned, not adjusted for: mismatch in experience |
Pons [54] 2010; Spain; level of evidence: III | – | – Definition: pre-surgery | – | Unknown | 96% Time to RTW: unknown | Adjusted for in analysis: none Mentioned, not adjusted for: none |
Pop et al. [61] 2016; Poland; level of evidence: IV | Employment status 1 y preop 1 y postop 10 y postop | Unknown Definition: 1 y preop, 1 y postop, 10 y postop | Unknown | Unknown | Employment status: 1 y preop: yes 28 (88%), no 0 (0%) Disability/retirement: 4 (12%) 1 y postop: yes 15 (47%), no 4 (13%) Disability/retirement: 13 (41%) 10 y postop: yes 13 (41%), no 1 (3%) Disability/retirement: 18 (57%) Time to RTW: unknown | Adjusted for in analysis: none Mentioned, not adjusted for: functional capacity, BMI, sex, place of residence, level of physical capacity, comorbidities, supervised rehabilitation |
Raguet et al. [41] 2015; France; level of evidence: III | Sports participation (n): | RTS (%) | Unknown | Adjusted for in analysis: none Mentioned, not adjusted for: age, surgeon’s advice, bearing type, postop pain, fear of luxation | ||
Ultrarunning | 7 | 7 | 100 | |||
UCLA score | – | 10 | Time to RTS: unknown | |||
Definition: pre-symptomatic | ||||||
Sankar et al. [55] 2013; Canada; level of evidence: II | Physical demands at work (n): | Unknown | 87% Time to RTW: ≤ 1 mo: 39%; ≤ 3 mo: 36%; 6–12 mo: 25% | Adjusted for in analysis: age, sex, education level, job sector, physical demands Mentioned, not adjusted for: workplace accommodations | ||
Low demand | 88 | 78 | ||||
High demand | 74 | 67 | ||||
Unclassified | 22 | 18 | ||||
Definition: pre-surgery | ||||||
Schmidutz et al. [37] 2012; Germany; level of evidence: IV | Sport participation (%): Low impact | 98% RTS (%) | Unknown | Adjusted for in analysis: sex, age, level of impact Mentioned, not adjusted for: recall bias, surgeons’ advice | ||
Cycling | 69 | 69 | 100 | |||
Hiking | 54 | 57 | > 100 | |||
Nordic walking | 12 | 18 | > 100 | |||
Gymnastics | 22 | 26 | > 100 | |||
Fitness/weight training | 22 | 38 | > 100 | |||
Dancing | 22 | 22 | 100 | |||
Swimming | 57 | 56 | 98 | |||
Golf | 1 | 1 | 100 | |||
Intermediate impact | ||||||
Badminton | 7 | 3 | 43 | |||
Inline skating | 4 | 1 | 25 | |||
Tennis | 15 | 3 | 20 | |||
Downhill skiing | 24 | 16 | 67 | |||
Cross-country skiing | 21 | 15 | 71 | |||
Riding | 7 | 3 | 43 | |||
Martial arts | 4 | 1 | 25 | |||
Bowling | 10 | 6 | 60 | |||
Rock climbing | 1 | 1 | 100 | |||
High impact | ||||||
Jogging | 9 | 3 | 33 | |||
Handball | 1 | 0 | – | |||
Volleyball | 7 | 3 | 43 | |||
Basketball | 4 | 1 | 25 | |||
Soccer | 9 | 1 | 11 | |||
Squash | 7 | 0 | - | |||
UCLA score | Unknown Definition: pre-surgery | 7.6 ± 1.9 (range 3–10) | Time to RTS: 1–2 mo: 27%; 3–4 mo: 25%; 5 to ≥ 6 mo: 48% | |||
Suarez et al. [56] 1996; Spain; level of evidence: IV | Type of work (n) | Unknown | 25% RTW (%) | Adjusted for in analysis: sex, age, workload, education, social security type, environment (rural/urban), family structure, underlying illness Mentioned, not adjusted for: cultural background | ||
Heavy work | 456 | 7 | 1.5 | |||
Moderate work | 134 | 84 | 63 | |||
Light work | 157 | 143 | 91 | |||
Definition: pre-surgery | Time to RTW: unknown | |||||
Suckel and Best [38] 2006; Germany; level of evidence: III | Sports participation (n): | RTS (%) | Unknown | Adjusted for in analysis: none Mentioned, not adjusted for: side, surgeon’s advice, risk of wear, golf experience | ||
Golf | 16 | 16 | 100 | |||
Definition: pre-surgery | Time to RTS: unknown | |||||
Tilbury et al. [57] 2015; the Netherlands; level of evidence: II | – | – Definition: pre-surgery | – | Unknown | 90% Time to RTW: 12.5 ± 7.6 wks Reason for no RTW: sick leave 2 (3%); retired 2 (3%); unknown 3 (4%) | Adjusted for in analysis: sex, age, BMI, education, radiographic severity, HOOS, EQ-5D score, Oxford Hip Score, SF-36 score Mentioned, not adjusted for: recall bias, postop complications |
Truszcynska et al. [58] 2013; Poland; level of evidence: III | – | – Definition: pre-surgery | – | Unknown | 59% All of these pts returned to their preop employment level Time to RTW: 94% within 6 mo | Adjusted for in analysis: sex, age, satisfaction with job, education level, compliance with exercise program, mental health Mentioned, not adjusted for: none |
Visuri et al. [59] 1987; Finland; level of evidence: III | Type of work (n): | Unknown | 67% Time to RTW: unknown | Adjusted for in analysis: age, sex, workload, social class, primary diagnosis, walking ability, pensioner groups Mentioned, not adjusted for: type of prosthesis | ||
Laborers | 303 | 27 | ||||
Service workers | 69 | 22 | ||||
Mental workers | 99 | 18 | ||||
Housewives | 68 | – | ||||
Definition: pre-surgery | ||||||
White [60] 1987; England; level of evidence: III | Workload (n) Heavy manual work | 8 Definition: Lifetime | 6 | Unknown | 92% 3 pts took up employment for the first time following THA Time to RTW: unknown | Adjusted for in analysis: diagnosis, workload Mentioned, not adjusted for: previous surgery, weight gain, patient activity |
3.3 Methodological Quality
Study | Selection | Comparability | Outcome | Total scorea | |||||
---|---|---|---|---|---|---|---|---|---|
Representativeness | Selection | Ascertainment | Outcome of interest | Assessment | FU | Adequacy of FU | |||
Abe et al. [29] | * | * | * | * | ** | – | * | – | 7 |
Arbuthnot et al. [30] | * | * | * | * | * | – | * | * | 7 |
Atkinson et al. [42] | * | * | * | * | * | – | * | * | 7 |
Berger et al. [43] | * | * | * | * | – | * | – | * | 6 |
Bohm [44] | * | * | * | * | ** | – | * | * | 8 |
Chatterji et al. [31] | * | * | * | * | ** | – | * | – | 7 |
Clyde et al. [45] | – | * | * | * | ** | – | * | – | 6 |
Danielsson [46] | * | * | * | * | * | – | * | * | 7 |
Del Piccolo et al. [40] | * | * | * | * | * | * | * | – | 7 |
Dubs et al. [28] | – | * | * | * | – | – | * | * | 5 |
Hara et al. [32] | * | * | * | * | ** | – | * | – | 7 |
Huch et al. [33] | * | * | * | * | ** | – | * | * | 8 |
Innmann et al. [34] | * | * | * | * | * | – | * | * | 7 |
Johnsson and Persson [47] | * | * | * | * | ** | * | * | * | 9 |
Karampinas et al. [35] | – | * | * | * | * | – | * | – | 5 |
Kleim et al. [12] | * | * | * | * | ** | – | – | – | 6 |
Kirschak et al. [48] | * | * | * | * | ** | * | * | * | 9 |
Lefevre et al. [36] | – | * | – | * | * | – | * | – | 4 |
Leichtenberg et al. [13] | * | * | * | * | ** | – | * | * | 8 |
Mikkelsen et al. [49] | – | * | * | * | * | – | – | * | 5 |
Mobasheri et al. [50] | * | * | * | * | ** | – | * | * | 8 |
Mont et al. [39] | – | * | – | * | * | – | * | – | 4 |
Nevitt et al. [62] | * | * | * | * | ** | – | * | * | 8 |
Pagnano et al. [51] | – | * | * | * | * | – | – | * | 5 |
Peak et al. [52] | * | * | * | * | – | * | – | – | 5 |
Poehling-Monaghan et al. [53] | * | – | * | – | – | – | – | – | 2 |
Pons [54] | * | * | * | * | – | * | * | – | 6 |
Pop et al. [61] | – | * | * | * | * | – | * | – | 5 |
Raguet et al. [41] | – | * | * | * | * | – | * | * | 6 |
Sankar et al. [55] | * | * | * | * | ** | – | * | * | 8 |
Schmidutz et al. [37] | * | * | * | * | ** | – | * | * | 8 |
Suarez et al. [56] | * | * | * | * | ** | * | – | – | 7 |
Suckel et al. [38] | – | * | – | * | – | – | * | – | 3 |
Tilbury et al. [57] | * | * | * | * | ** | – | * | * | 8 |
Truszczynska et al. [58] | * | * | * | * | * | * | * | – | 7 |
Visuri et al. [59] | * | * | * | * | ** | * | * | * | 9 |
White [60] | – | * | * | * | * | * | * | * | 7 |
3.4 Return to Sports
Preoperative reference for RTS | No. of pts participating in any sport | RTS (%) | |
---|---|---|---|
Preoperatively | Postoperatively | ||
Overall (14 studies) | 1125 | 1130 | 100 |
Pre-surgery participation as reference for RTS (10 studies) | 938 | 977 | 104 |
Pre-symptomatic participation as reference for RTS (4 studies) | 187 | 153 | 82 |
High-quality studies; pre-surgery participation as reference for RTS (2 studies) | 214 | 280 | 131 |
High-quality studies; lifetime participation as reference for RTSa (1 study) | 408 | 218 | 53 |
Impact level | Preoperative sports participation (11 studies) | Postoperative sports participation (11 studies) | ||||
---|---|---|---|---|---|---|
Sports (n) | Pts (n) | Average sports/pt, n (%) | Sports (n) | Pts (n) | Average sports/pt, n (%) | |
Low (e.g., cycling, swimming, golfing) | 1115 | 1605 | 0.69 (62) | 1090 | 1605 | 0.68 (69) |
Intermediate (e.g., hiking, downhill skiing) | 427 | 1605 | 0.27 (24) | 372 | 1605 | 0.23 (23) |
High (e.g., tennis, running, ball sports) | 250 | 1605 | 0.16 (14) | 122 | 1605 | 0.08 (8) |
Total | 1792 | 1605 | 1.12 | 1584 | 1605 | 0.99 |
3.5 Return to Work
Number of working patients | Time to RTW | |||||
---|---|---|---|---|---|---|
Preoperative (n) | Postoperative (n) | RTW (%) | Patients (n) | Inability to work (weeks) | ||
Overall (23 studies) | 3097 | 2138 | 69 | Overall (8 studies) | 746 | 8.9 |
High quality (9 studies) | 1492 | 1242 | 83 | High quality (2 studies) | 157 | 11.4 |
Published in or before 2000 (16 studies) | 1238 | 548 | 44 | Published in or before 2000 (0 studies) | – | – |
Published after 2000 (7 studies) | 1859 | 1590 | 86 | Published after 2000 (8 studies) | 746 | 8.9 |