The proportion of patients physically active before and after a hip implantation increased in the last decade by 14%, Swiss researchers reported at the EFORT Congress in Istanbul. The sustainable success of hip replacements was confirmed in a recent long-term study which nevertheless cautioned against excessive physical activity.
Istanbul, 5 June 2013 – Total hip implantations provide significant and enduring improvement in the level of physical activity in men and women of all age categories. A study confirming this, by the Geneva University Hospital (Switzerland), was presented at the 14th Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) in Istanbul. About 7,500 experts are currently discussing the latest developments in that specialty field. “Great expectations are commonly connected with hip implantations: pain should disappear and mobility should return,” explained Dr Anne Lübbeke-Wolff, author of the study. “However, some patients raise their expectations too high and are disappointed after the surgery. We therefore wanted to look more objectively at the course of physical activity before and after the intervention.” Specifically, the issue in question was whether, in the last ten years, physical activity of patients in a given age category had changed before and after a hip implantation. The study examined the lifestyle of more than 2,900 patients before and approximately 1,600 patients after an operation. The subjects were an average of 68 years old at the time of surgery and 56% were female.
More active than ever
The results are encouraging. While 68% of the subjects between 2000 and 2003 claimed to have maintained a sedentary lifestyle, the figure from 2007 to 2011 was only 54%, even though they were in the same age group. Total hip arthroplasty patients are also more active than ever now. Of those who were operated on between 2000 and 2003, 53% admitted five years after the intervention to being couch potatoes. The figure was only 39% for patients operated on from 2004 to 2011. “The study confirms that people do tend to exercise more than they did just a few years ago,” said EFORT President Prof Pierre Hoffmeyer (University Hospital of Geneva, Switzerland). The increase would be consistent with activity surveys of the general adult Swiss population. International studies also confirm the trend towards a moderate increase of exercise. “The reasons for this are complex. In any case, we can say that in regard to our cohort, patients increasingly are in better overall condition. This explains part of the higher level of activity. It also indicates an increasing awareness in the population of the importance of physical exercise. The fact is, there has been a 14% increase over the past decade in the proportion of patients that are physically active before and after hip implantation,” Prof Hoffmeyer said.
Sustaining mobility
The study also provides evidence that, to a large extent, surgery can help restore physical activity. “Because of hip disorders, men and women move only half as much prior to implantation than do those in healthy condition. An operation can still greatly improve the quality of life. Even ten years after the surgery, the degree of physical activity is much higher than immediately before the operation, this despite the advancing age of the patients,” Dr Lübbeke-Wolff reported. At any point in time, the survey noted, women exercise less than men. “Theories are quite diverse about the relationship between gender differences and activity, ranging from the different way boys and girls play to traditional role models that still seem to prevail in the older generation. Men are more likely to find time for physical exercise, as well as for recreation, while women tend to be more concerned with household affairs,” the study’s author explained.
Caution: not too much exercise
The aim of total hip implantations is to relieve pain and to restore a patient’s mobility as much as possible. Some patients become too active after the implantation, however, and thus shorten the life of the prosthesis. “It is very important in this regard that physicians treating patients conduct a detailed discussion with them about their previous sport, leisure and work activities. That includes asking them about their expectations and informing them about the kind of activities that are possible with a prosthesis. This should take place before the operation and continue during the follow-up checks. Patients should know that, on average, the operation leads to a significant improvement in activity compared to what could be achieved before the operation. Likewise, they should understand that they may not quite reach the level of activity enjoyed prior to the onset of arthrosis symptoms, especially not those patients under age 55,” Prof Hoffmeyer cautioned.
Hip joints: Facts and Figures
Osteoarthritis among the diseases in developed countries that most lead to disability. Worldwide, according to the WHO, 9.6% of men and 18% of women are affected. The implantation of an artificial hip joint has proven to be an effective and cost-efficient intervention for the treatment of severe cases. The operation is carried out mainly in people aged 60 or over. As OECD data shows, such interventions are sharply increasing, not least because of demographic trends. The number of hip implantations has increased in Denmark by 40% between 2000 and 2010, in Spain by 25% and in France by 10% – a development impacting the economics of health care. The cost of a hip replacement in Europe was estimated to average 7,300 Euros in 2009, which probably contributes to the enormous regional differences in the operations. Cyprus’ 15 hip implantations per 100,000 inhabitants was just one-tenth of the EU-24 average, which is 153 hip replacements per 100,000 population. Germany nearly doubles the EU average with 295 surgeries per 100,000 inhabitants. Age-standardised numbers change little in this ranking. Whether or not patients in Europe get a hip implantation, therefore, seems to depend less on medical needs than on economic conditions.
About EFORT
The European Federation of National Associations of Orthopaedics and Traumatology (EFORT) is the umbrella organisation linking Europe´s national orthopaedic societies. EFORT was founded in 1991 in the Italian Marentino. Today it has 42 national member societies from 43 member countries and six associate scientific members.
EFORT is a non-profit organisation. The participating societies aim at promoting the exchange of scientific knowledge and experience in the prevention and treatment of diseases and injuries of the musculoskeletal system. EFORT organises European congresses, seminars, courses, forums and conferences. It also initiates and supports basic and clinical research.
Sources: EFORT Abstract 3595: Trends in patient physical activity before and after primary THA; How do we eat and exercise? Trends in nutrition and physical activity in Switzerland.: Swiss health observatory; 2010.; Knuth AG, Hallal PC. Temporal trends in physical activity: a systematic review. J Phys Act Health 2009; 6(5): 548-59; J Women Aging. 2005;17(1-2):55-70. Gender differences in physical activity and walking among older adults. http://www.ncbi.nlm.nih.gov/pubmed/15914419; OECD (2012): „Health at a Glance“, OECD Publishing: http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-europe-2012/hip-and-knee-replacement_9789264183896-37-en
