The evolution of patient sporting activities after hip resurfacing has not yet been studied. A scoring algorithm to quantify sporting activity was developed to compare type of activity, frequency, duration, and overall activity level in the early postoperative period and at mid- to long-term follow-up. Quantification of sporting activity is a challenging undertaking but should become a useful tool to study the relationship between failure rates and the use of prosthesis.
The evolution of patient sporting activities after hip resurfacing has not yet been studied. The Impact and Cycle Score (ICS), a scoring algorithm to quantify sporting activity, was developed to compare type of activity, frequency, duration, and overall activity level in the early postoperative period and at mid- to long-term follow-up. The scoring of the ICS included (1) the impact score (IS), which rated activities based on the predominant type of displacement involved and then multiplied this rating by frequency and duration scores, and (2) the hip cycle score (HCS), which rated activities based on the number of hip cycles per unit of time characterizing the activity and then multiplied this rating by frequency and duration scores. All patients were also evaluated using the University of California, Los Angeles (UCLA) hip scoring system. Mean time for the first survey was 1.8 years postoperatively (range, 1.0–4.9 years) and 9.1 years (range, 5.0–13.4 years) for the second survey.
Positive correlations were found between IS and the UCLA activity score and between HCS and the UCLA activity score. Mean IS decreased from 30.4 to 26.5 between the surveys ( P = .0116), whereas the mean HCS decreased from 35.8 to 30.4 ( P = .0020). Competitive participation increased from 5.5% to 10.1% among the listed activities ( P = .0129), and high-impact sports increased from 12.4% to 17.5% among the listed activities ( P = .0454). Patients younger than 50 years at surgery maintained all activity scores between the surveys, whereas patients aged 50 or older showed a significant decline in IS, HCS, and UCLA hip score. Although the overall activity level remains high, especially in patients younger than 50 years at surgery, the older patients showed a decline in overall quantity of activity overtime. This decline could be a result of the natural aging process or a possible “wear off” effect of the initial enthusiasm for sporting activities associated with a successful hip procedure. However, the increase in competitive participation and the proportion of impact activities indicate the patients’ confidence in the durability of the prosthesis.
Restoration of original lifestyle could be considered the ultimate goal of hip arthroplasty. Wright and colleagues showed that returning to professional and recreational activities was the most important reason why patients undergo total hip arthroplasty (THA) aside from pain relief and improving walking function. These recreational activities often include sporting activities, especially in young patients for whom sports constitute an important part of overall physical activity. It is now established that the patient population receiving metal-on-metal hip resurfacing devices is usually younger and more active than the general patient population receiving a conventional THA.
Participation in sports after hip resurfacing has been described at short-term follow-up, with greater than 90% of the patients returning to sporting activities. A randomized clinical trial found a difference in overall activity score in favor of hip resurfacing when compared with conventional THA. High-impact activities were shown to have a detrimental effect on the survivorship of hip resurfacing with polyethylene bearings, and surgeons usually agree that high-impact sports should not be recommended after a hip arthroplasty. However, outcome of the procedure is likely affected by not only what patients do after surgery but also how much and how often. In addition, patient involvement in sports may not be constant over time, and no attempt has been made to study the evolution of the type, amount, and level of physical activity the patients regularly engage in after hip resurfacing.
The purpose of this study is to compare the nature of activities, frequency and intensity of participation, and duration of sessions between the short postoperative period and the mid- to long-term follow-up in a group of patients treated with metal-on-metal hip resurfacing arthroplasty.
Materials and methods
Instruments
Data collection was performed using a survey available online as an encrypted document. The patients were given the possibility to report up to three sporting activities that they were participating in on a regular basis. For each sport mentioned (chosen from an extensive list), the patient selected the frequency of participation and the duration of typical sessions. The intensity level was also recorded as patients were asked to indicate if they were participating competitively or for recreational purposes only. The patients also reported if they were beginner, intermediate, advanced, or expert level for each activity selected. The survey was filled out at each clinical follow-up with a minimum of 1 year postsurgery. UCLA scores were recorded and SF-12 quality of life scores were computed at the last follow-up. A scoring algorithm was developed to quantify the answers to the survey and named the Impact and Cycle Score (ICS).
The ICS included two scores:
- 1.
Impact score (IS): activities were rated based on the predominant type of displacement involved and then multiplied by frequency and duration scores:
Patient IS = Σ (Activity IS x F x D), where Activity IS is the impact score associated with an activity, F is the frequency score, and D is the duration score
- 2.
Hip cycle score (HCS): activities were rated based on the number of hip cycles per unit of time characterizing the activity and then multiplied by frequency and duration scores:
Patient HCS = Σ (Activity HCS x F x D), where Activity HCS is the hip cycle score associated with an activity, F is the frequency score, and D is the duration score.
Details of the scoring algorithm are presented in Tables 1 and 2 .
| Activity | Impact Score | Hip Cycle Score |
|---|---|---|
| Aerobics | 3 | 3 |
| Archery | 1 | 1 |
| Badminton | 4 | 3 |
| Ballet/ballroom dancing | 2 | 2 |
| Baseball/softball | 4 | 2 |
| Basketball | 4 | 3 |
| Bowling | 2 | 1 |
| Canoeing | 1 | 1 |
| Cross-country skiing | 2 | 4 |
| Cycling | 2 | 4 |
| Downhill skiing (groomed) | 2 | 2 |
| Downhill skiing (moguls) | 4 | 2 |
| Cardio machine (eg, step, elliptical) | 2 | 3 |
| European handball | 4 | 3 |
| Golf (using a cart) | 1 | 1 |
| Golf (walking between holes) | 1 | 3 |
| Handball | 4 | 3 |
| Hockey | 4 | 2 |
| Horseback riding | 1 | 1 |
| Ice skating | 2 | 2 |
| Martial arts | 4 | 2 |
| Motocross riding | 3 | 1 |
| Pilates | 1 | 1 |
| Racquetball | 4 | 3 |
| Rock climbing | 1 | 1 |
| Rollerblading | 2 | 2 |
| Rugby | 4 | 3 |
| Rowing | 2 | 2 |
| Running | 4 | 4 |
| Sailing | 1 | 1 |
| Scuba diving | 2 | 2 |
| Soccer | 4 | 3 |
| Squash | 4 | 3 |
| Surfing | 2 | 1 |
| Swimming | 1 | 1 |
| Tennis (doubles) | 3 | 2 |
| Tennis (singles) | 4 | 3 |
| Volleyball | 4 | 2 |
| Walking, hiking, backpacking | 2 | 3 |
| Water skiing | 2 | 2 |
| Weightlifting | 2 | 1 |
| Wrestling | 4 | 2 |
| Yoga | 1 | 1 |
| Frequency of Sessions (times per month) | Frequency Score | Duration of Sessions (min) | Duration Score |
|---|---|---|---|
| 1–4 | 1 | 0–30 | 1 |
| 5–8 | 2 | 30–60 | 2 |
| 9–12 | 3 | 60–120 | 3 |
| >12 | 4 | >120 | 4 |
For the IS scores, activities with no or minimal displacement were rated 1; activities for which walking was the primary mode of locomotion, or in which the hip joint reaction forces were limited (low impact) were rated 2; activities with limited displacement but some impact were rated 3; and activities for which the primary modes of displacement were running or jumping were rated 4.
For the HCS score, the activities were rated from 1 to 4 based on pilot data collected with pedometers or accelerometers to determine the number of hip cycles necessary per unit of time for each activity.
Subjects
Between 1996 and 2003, 547 patients (636 hips) received metal-on-metal surface arthroplasties and were asked to fill out the sports activity survey at least 1 year postsurgery and then yearly. Of these patients, 445 completed at least one survey between 1 and 5 years after surgery, and 201 of these filled out at least one subsequent survey 5 years or more after the initial data collection; these patients constituted the study group. The average age of the patients was 49.6 years (range, 15–77 years) and men accounted for 74.6% of the study group. The average weight was 82.7 kg (range, 47–164 kg) and average body mass index was 26.9 (range, 19–46). Initial causes included osteoarthritis (68%), developmental dysplasia of the hip (11%), osteonecrosis (8%), trauma (6%), and others (7%), including Legg-Calve-Perthes disease, slipped capital femoral epiphysis, epiphyseal dysplasia, rheumatoid disease, and pigmented villonodular synovitis. Of the patients who underwent hip surgery, 6% had undergone previous surgeries; 28% of the patients had bilateral hip resurfacing and 4% had various types of conventional THAs on the contralateral hip. Among the study group, 8 patients had undergone revision surgery between the surveys.
Implants and Surgical Technique
The prosthesis used in the present study was the Conserve® Plus (Wright Medical Technology, Inc, Arlington, TN, USA). The surgical technique used for implanting the devices was described in a previous report.
Statistics
The Wilcoxon signed-rank test was used to assess differences between early and last follow-up IS and HCS. Chi-square analysis was performed to determine changes in the nature and intensity of the sports participation. Pearson correlation coefficients were calculated between sports survey scores (IS and HCS) and the other outcome scores (SF-12 and UCLA). Reliability of the two ICS components was assessed through computation of intraclass correlation coefficients on a subset of 37 patients on whom data was collected twice within 1 month, with a minimum of 1 day between the two surveys.
Related posts:
Comparison of Functional Results of Hip Resurfacing and Total Hip Replacement: A Review of the Literature
Imaging of Metal-On-Metal Hip Resurfacing
A Prospective Metal Ion Study of Large-Head Metal-on-Metal Bearing: A Matched-Pair Analysis of Hip Resurfacing Versus Total Hip Replacement
Complications After Metal-on-Metal Hip Resurfacing Arthroplasty
The Future of Hip Resurfacing
A Prospective Metal Ion Study of Large-Head Metal-on-Metal Bearing: A Matched-Pair Analysis of Hip Resurfacing Versus Total Hip Replacement
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