Table 1.
Return to sports and work after total hip arthroplasty: data extracted from studies included in the review (n = 37)
| 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 |
Levels of evidence: I = randomized controlled study, II = prospective study, III = retrospective (comparative) study, IV = retrospective case series
ASA American Society of Anesthesiologists, BFH big femoral head arthroplasties, BMI body mass index, Co co-morbidities, DA direct posterior, EQ-5D EuroQol-5D, F female, HHS Harris Hip Score, HOOS Hip disability and Osteoarthritis Outcome Score, M male, mo months, MP mini-posterior, NR not reported, NS not significant, OA osteoarthritis, postop postoperative, preop preoperative, pts patients, RG restricted group, ROM range of motion, RTS return to sports, RTW return to work, SMF short modular femoral hip system, THA total hip arthroplasty, UCLA University of California, Los Angeles, UG unrestricted group, wk(s) week(s), y years
aAge is presented in years unless otherwise indicated and BMI is presented in kg/m2
bChatterji et al. reported return to sports of 175 of 188 patients (93%) performing sports preoperatively, plus 21 patients who took up at least one sport postoperatively
cDel Picolo et al. used different numbers in the abstract and in the methods section. We report number that was stated in the methods section
dTotal RTW percentage is 99% in original article