Introduction
Total hip arthroplasty (THA), otherwise known as total hip replacement, is a common surgery performed to relieve pain in patients with hip osteoarthritis. Hip replacements have been well documented as successful procedures with good long-term outcomes. Patient’s expectations of hip replacements have increased, with many patients desiring to return to high levels of activity following hip replacements. There is a lack of consensus among orthopedic surgeons regarding what levels of athletic activity should be allowed or recommended after a hip replacement. According to Healy et al,2,3 jogging is classified as a “high-impact” and “not recommended” activity following hip replacements due to the high hip contact forces generated. However, jogging is known to have significant health benefits, including improving cardiovascular endurance and strength. Jogging is generally recommended for people with several different health conditions, including cardiovascular disease, however research on the benefits and risks of jogging post-hip replacement is lacking.
There is limited research on jogging after hip replacements and the impact on component survival. There is also limited research on participation rates, jogging parameters, and the reasons people choose not to participate in jogging post-hip replacement. The authors state that the purpose of this study is to investigate the number of patients who participated in jogging after a hip replacement, the reasons given by those who were interested in but did not participate in jogging, the parameters surrounding post-operative jogging, short-term clinical and radiographic results for post-operative joggers, and factors related to post-operative jogging.
Participants
This study included 804 hips from 608 patients who underwent primary total hip replacements at two separate hospitals. The patients who answered a self-completed questionnaire during a routine follow-up visit were included in the study.
- 804 hips from 608 total patients (85 men and 523 women):
- Mean age: 62 years (range: 26-98 years)
- Mean body mass index (BMI): 23.2 (range: 14.7-34.2)
- Mean post-operative follow-up duration: 4.8 years (range: 2.3-7.8 years)
- Bilateral hip replacement (both hips): 196 patients
- Unilateral hip replacement (one hip): 412 patients
- Hip resurfacing arthroplasty (HRA): performed in 97 hips of 81 patients
- Conventional total hip arthroplasty (THA): performed in 707 hips of 527 patients
Methods
Participants were selected from two local participating hospitals after filling out a survey at a routine follow-up appointment. Participants underwent either bilateral (both hips) or unilateral (one hip) total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA) procedures. Several different HRA and THA components were used per surgeon’s choice in each patient as listed in the article. Five patients were excluded from the study due to other medical reasons or declining the survey. The post-operative rehabilitation protocol is as follows below:
- Post-Operative Rehabilitation Protocol
- All patients were allowed to walk with full weightbearing on post-operative day 1
- Most patients could walk without a cane at post-operative week 1-3
- Most patients returned to usual daily activities at post-operative month 1
- Patients who wanted to jog were allowed to do so at 6 months post-operatively
- Patients were also allowed to participate in sports activities at 6 months post-operatively, with the exception of contact sports and martial arts (soccer, baseball, basketball, volleyball, rugby, judo, and karate)
All patients were asked to give information about pre-operative and post-operative jogging habits. Those who jogged after their hip replacement answered additional questions about jogging frequency, distance, duration, velocity, and symptoms. Those who did not jog after their hip replacement were asked to provide reasons as to why they did not. Patients were asked to complete two questionnaires: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) self-assessment questionnaire for pain, stiffness, and physical function (higher score indicates worse pain, stiffness, and physical function) and University of California-Los Angeles (UCLA) activity scale (higher score indicates higher activity levels). The researchers evaluated serial radiographs (X-rays) to identify any implant loosening, weight-bearing wear, and bone degeneration around the components.
Results
Of the 608 patients, 33 patients (5.4%) were habitual pre-operative joggers and 23 (3.8%) continued habitual post-operative jogging. The 23 post-operative jogger group was comprised of 13 men and 10 women with mean age of 57 +/- 12 years. Ten of 81 patients (12.3%) who underwent hip resurfacing and 13 of 527 patients (2.5%) who underwent hip replacement regularly participated in post-operative jogging. Post-operative jogging was performed on average 4 times per week (range: 1-7 times per week) for a distance of 3.6 km (range: 0.5-15 km) over a duration of 29 minutes (range: 5-90 minutes) with a velocity of 7.7 km/hour (range: 3-18 km/hour). Additionally, 5 of 23 patients (21.7%) regularly jogged more than 10 km/week.
Of the 585 patients who did not participate in post-operative jogging, 511 (87%) stated they had no interest and 74 patients (13%) stated they are interested in jogging but do not currently. Reasons provided by the non-jogging group were anxiety (45 patients, 61%), that jogging was impossible because of pain, decreased range of motion, and muscle weakness (18 patients, 24%), and low back or knee pain (11 patients, 15%).
On the WOMAC questionnaire, joggers had significantly lower mean scores (which is more desirable) of both pain and physical function than non-joggers, with no significant difference in stiffness between the two groups. On the UCLA activity score, joggers had significantly higher scores (which is more desirable) than non-joggers. Of the jogging group, no patients complained of pain during post-operative jogging, no patient’s hips showed evidence of osteolysis, implant loosening, abnormal component migration, or excessive wear at an average 5-year follow-up on X-ray imaging, and no patient had a history of post-operative hip dislocation.
Summary
In this research study, 3.8% of total hip replacement patients participated in post-operative jogging. This study found no negative influences of jogging on implant survival at a short-term post-operative follow-up. The findings of this study do have some limitations, as stated in their conclusion section. One notable limitation is that this study had a short follow-up period of an average of 4.8 years, therefore additional research is needed to understand the longer-term effects of jogging on total hip replacements. Additional key findings include that 65.2% of post-operative joggers were not pre-operative joggers. The most common reason for avoiding post-operative jogging was anxiety, which could hopefully be improved through education and more definitive guidelines on post-hip replacement activity participation and safety.
At Physical Therapy First, our goal is to assist members of our community in returning to their desired activity level and improving quality of life. Our physical therapists are trained to assist patients maximize their post-operative performance which may include jogging for previous runners. Returning to higher impact activities will depend on the individual’s recovery in conjunction with their surgeon’s recommendations. In conclusion, at short-term follow-up participation in post-operative jogging did not lead to any significant poor outcomes in patients with total hip replacements. Longer follow-up periods are needed to fully understand the effects of habitual jogging on hip replacements.
References
- Abe H, Sakai T, Nishii T, Takao M, Nakamura N, Sugano N. Jogging after total hip arthroplasty. Am J Sports Med. 2014;42(1):131-137. doi:10.1177/0363546513506866
- Healy WL, Iorio R, Lemos MJ. Athletic activity after joint replacement. Am J Sports Med. 2001;29(3):377-388. doi:10.1177/03635465010290032301
- Healy WL, Sharma S, Schwartz B, Iorio R. Athletic activity after total joint arthroplasty. J Bone Joint Surg Am. 2008;90(10):2245-2252. doi:10.2106/JBJS.H.00274