Changes in Physical Activity After Total Hip or Knee Arthroplasty: A Systematic Review and Meta‐Analysis of Six‐ and Twelve‐Month Outcomes

Objective Little is known about the extent to which physical activity (PA) changes following total knee or hip joint replacement relative to pain, physical function and quality of life. Our objective was to conduct a systematic review and meta-analysis on changes in PA relative to pain, quality of life and physical function after total knee or hip joint replacement. Methods We searched PubMed (Medline), Embase and Cinahl, for peer-reviewed, English-language cohort studies measuring PA with an accelerometer from pre-surgery to post-surgery. Random-effects models were used to produce standardized mean differences (SMDs) for PA, quality of life, pain, and physical function outcomes. Heterogeneity was measured with I2. Results Seven studies (336 participants) met eligibility criteria. No significant increase in PA was found at 6-months (SMD 0.14; 95% CI -0.05 to 0.34; I2=0%) and a small-moderate significant effect was found for increasing PA at 12-months (SMD 0.43; 95% CI 0.22 to 0.64; I2=0%). Large improvements at 6-months in physical function (SMD 0.97; 95% CI 0.12 to 1.82; I2=92.3%), pain (SMD -1.47; 95% CI -2.28 to -0.65; I2=91.6%), and quality of life (SMD 1.02; 95% CI 0.30 to 1.74; I2=83.2%) were found. Conclusions Physical activity did not change at 6-months and a small-moderate improvement was found at 12-months post-surgery, despite large improvements in quality of life, pain, and physical function. Reasons for the lack of increased PA are unknown but may be behavioral in nature as sedentary lifestyle is difficult to change. Changing sedentary behavior should be a future focus among this subgroup. This article is protected by copyright. All rights reserved.