The Role of Physical Activity and Rehabilitation Following Hip and Knee Arthroplasty in the Elderly

Rocco Papalia, Stefano Campi, Ferruccio Vorini, Biagio Zampogna, Sebastiano Vasta, Giuseppe Papalia, Chiara Fossati, Guglielmo Torre, Vincenzo Denaro, Rocco Papalia, Stefano Campi, Ferruccio Vorini, Biagio Zampogna, Sebastiano Vasta, Giuseppe Papalia, Chiara Fossati, Guglielmo Torre, Vincenzo Denaro

Abstract

Hip and knee replacement is an effective treatment for symptomatic, end-stage hip and knee osteoarthritis, aiming to relieve pain and restore joint function. Several postoperative rehabilitation protocols and physical activities are proposed in routine clinical practice. However, their effect on clinical outcome and implant revision in patients undergoing joint replacement is still unclear. A systematic review of the literature was performed through a comprehensive search on online databases including Pubmed-Medline, Cochrane central, and Google scholar. We included all the available studies on postoperative physical activity and rehabilitation protocols after total knee and total hip arthroplasty in patients older than 65 years. The primary endpoint was to evaluate the effect of physical activity and rehabilitation on clinical outcome; the secondary outcome was to determine the effect on patients' quality of life (QoL) and implant survival. Although the heterogeneity of the rehabilitation protocols and outcome measures did not allow to draw definitive conclusions, most studies suggested that aquatic therapy, ergometer cycling, and fast-track protocols have a beneficial effect on muscle strength, gait speed, and main clinical scores after total hip arthroplasty. Similarly, enhanced rehabilitation protocols produced an improvement in primary and secondary outcomes after total knee arthroplasty.

Keywords: elderly; hip arthroplasty; knee arthroplasty; physical activity; physiotherapy; rehabilitation.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study inclusion process.

References

    1. Zambon A., Bertocco S., Vitturi N., Polentarutti V., Vianello D., Crepaldi G. Relevance of hepatic lipase to the metabolism of triacylglycerol-rich lipoproteins. Biochem. Soc. Trans. 2003;31:1070–1074. doi: 10.1042/bst0311070.
    1. Cross M., Smith E., Hoy D., Nolte S., Ackerman I., Fransen M., Bridgett L., Williams S., Guillemin F., Hill C.L., et al. The global burden of hip and knee osteoarthritis: Estimates from the Global Burden of Disease 2010 study. Ann. Rheum. Dis. 2014;73:1323–1330. doi: 10.1136/annrheumdis-2013-204763.
    1. Moher D., Liberati A., Tetzlaff J., Altman D.G. PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6:e1000097. doi: 10.1371/journal.pmed.1000097.
    1. Higgins J.P.T., Altman D.G., Gøtzsche P.C., Jüni P., Moher D., Oxman A.D., Savovic J., Schulz K.F., Weeks L., Sterne J.A.C., et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. doi: 10.1136/bmj.d5928.
    1. Slim K., Nini E., Forestier D., Kwiatkowski F., Panis Y., Chipponi J. Methodological index for non-randomized studies (minors): Development and validation of a new instrument. Anz J. Surg. 2003;73:712–716. doi: 10.1046/j.1445-2197.2003.02748.x.
    1. Gschwend N., Frei T., Morscher E., Nigg B., Loehr J. Alpine and cross-country skiing after total hip replacement: 2 cohorts of 50 patients each, one active, the other inactive in skiing, followed for 5-10 years. Acta Orthop. Scand. 2000;71:243–249. doi: 10.1080/000164700317411825.
    1. Lavernia C.J., Sierra R.J., Hungerford D.S., Krackow K. Activity level and wear in total knee arthroplasty: a study of autopsy retrieved specimens. J. Arthroplasty. 2001;16:446–453. doi: 10.1054/arth.2001.23509.
    1. Jones D.L., Cauley J.A., Kriska A.M., Wisniewski S.R., Irrgang J.J., Heck D.A., Kwoh C.K., Crossett L.S. Physical activity and risk of revision total knee arthroplasty in individuals with knee osteoarthritis: A matched case-control study. J. Rheumatol. 2004;31:1384–1390.
    1. Mont M.A., Marker D.R., Seyler T.M., Jones L.C., Kolisek F.R., Hungerford D.S. High-impact sports after total knee arthroplasty. J. Arthroplasty. 2008;23:80–84. doi: 10.1016/j.arth.2008.04.018.
    1. Giaquinto S., Ciotola E., Dall’armi V., Margutti F. Hydrotherapy after total hip arthroplasty: a follow-up study. Arch. Gerontol. Geriatr. 2010;50:92–95. doi: 10.1016/j.archger.2009.02.005.
    1. Giaquinto S., Ciotola E., Dall’Armi V., Margutti F. Hydrotherapy after total knee arthroplasty. A follow-up study. Arch. Gerontol. Geriatr. 2010;51:59–63. doi: 10.1016/j.archger.2009.07.007.
    1. Liebs T.R., Herzberg W., Rüther W., Haasters J., Russlies M., Hassenpflug J. Ergometer cycling after hip or knee replacement surgery: a randomized controlled trial. J. Bone Joint Surg. Am. 2010;92:814–822. doi: 10.2106/JBJS.H.01359.
    1. Liebs T.R., Herzberg W., Rüther W., Haasters J., Russlies M., Hassenpflug J. Multicenter Arthroplasty Aftercare Project Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty. Arch. Phys. Med. Rehabil. 2012;93:192–199. doi: 10.1016/j.apmr.2011.09.011.
    1. Mayr H.O., Reinhold M., Bernstein A., Suedkamp N.P., Stoehr A. Sports activity following total knee arthroplasty in patients older than 60 years. J. Arthroplasty. 2015;30:46–49. doi: 10.1016/j.arth.2014.08.021.
    1. Winther S.B., Foss O.A., Wik T.S., Davis S.P., Engdal M., Jessen V., Husby O.S. 1-year follow-up of 920 hip and knee arthroplasty patients after implementing fast-track. Acta Orthop. 2015;86:78–85. doi: 10.3109/17453674.2014.957089.
    1. Heiberg K.E., Figved W. Physical Functioning and Prediction of Physical Activity After Total Hip Arthroplasty: Five-Year Followup of a Randomized Controlled Trial. Arthritis Care Res. 2016;68:454–462. doi: 10.1002/acr.22679.
    1. Paxton E.W., Torres A., Love R.M., Barber T.C., Sheth D.S., Inacio M.C.S. Total joint replacement: A multiple risk factor analysis of physical activity level 1-2 years postoperatively. Acta Orthop. 2016;87 Suppl 1:44–49. doi: 10.1080/17453674.2016.1193663.
    1. Taniguchi M., Sawano S., Kugo M., Maegawa S., Kawasaki T., Ichihashi N. Physical Activity Promotes Gait Improvement in Patients With Total Knee Arthroplasty. J. Arthroplasty. 2016;31:984–988. doi: 10.1016/j.arth.2015.11.012.
    1. Hiyama Y., Wada O., Nakakita S., Mizuno K. Factors Affecting Mobility after Knee Arthroplasty. J. Knee Surg. 2017;30:304–308.
    1. Mitrovic D., Davidovic M., Erceg P., Marinkovic J. The effectiveness of supplementary arm and upper body exercises following total hip arthroplasty for osteoarthritis in the elderly: a randomized controlled trial. Clin. Rehabil. 2017;31:881–890. doi: 10.1177/0269215516655591.
    1. Valle C., Sperr M., Lemhöfer C., Bartel K.E., Schmitt-Sody M. [Does Sports Activity Influence Total Knee Arthroplasty Durability? Analysis with a Follow-Up of 12 Years] Sportverletz. Sportschaden Organ Ges. Orthopadisch-Traumatol. Sportmed. 2017;31:111–115.
    1. Mikkelsen L.R., Mikkelsen S.S., Christensen F.B. Early, intensified home-based exercise after total hip replacement--a pilot study. Physiother. Res. Int. J. Res. Clin. Phys. Ther. 2012;17:214–226. doi: 10.1002/pri.1523.
    1. Rahmann A.E., Brauer S.G., Nitz J.C. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch. Phys. Med. Rehabil. 2009;90:745–755. doi: 10.1016/j.apmr.2008.12.011.
    1. Moffet H., Collet J.-P., Shapiro S.H., Paradis G., Marquis F., Roy L. Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: A single-blind randomized controlled trial. Arch. Phys. Med. Rehabil. 2004;85:546–556. doi: 10.1016/j.apmr.2003.08.080.
    1. Valtonen A., Pöyhönen T., Sipilä S., Heinonen A. Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement. Arch. Phys. Med. Rehabil. 2010;91:833–839. doi: 10.1016/j.apmr.2010.03.002.
    1. Valtonen A., Pöyhönen T., Sipilä S., Heinonen A. Maintenance of aquatic training-induced benefits on mobility and lower-extremity muscles among persons with unilateral knee replacement. Arch. Phys. Med. Rehabil. 2011;92:1944–1950. doi: 10.1016/j.apmr.2011.07.191.
    1. Bauman S., Williams D., Petruccelli D., Elliott W., Beer J. de Physical Activity After Total Joint Replacement: A Cross-Sectional Survey. Clin. J. Sport Med. 2007;17:104–108. doi: 10.1097/JSM.0b013e3180379b6a.
    1. Bandholm T., Wainwright T.W., Kehlet H. Rehabilitation strategies for optimisation of functional recovery after major joint replacement. J. Exp. Orthop. 2018;5:44. doi: 10.1186/s40634-018-0156-2.
    1. Berg U., Berg M., Rolfson O., Erichsen-Andersson A. Fast-track program of elective joint replacement in hip and knee-patients’ experiences of the clinical pathway and care process. J. Orthop. Surg. 2019;14:186. doi: 10.1186/s13018-019-1232-8.
    1. Petersen P.B., Jørgensen C.C., Kehlet H. Fast-track hip and knee arthroplasty in older adults-a prospective cohort of 1,427 procedures in patients ≥85 years. Age Ageing. 2019;49:425–431. doi: 10.1093/ageing/afz176.
    1. Hansen T.B. Fast track in hip arthroplasty. EFORT Open Rev. 2017;2:179–188. doi: 10.1302/2058-5241.2.160060.

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