Physically-demanding work and leisure activities following lower limb arthroplasty, and mid to long-term outcomes

Abstract

Lower limb arthroplasty has been a major success. However, it is known that physically-demanding work increases the risk of primary hip and knee OA, therefore it is possible that returning to work involving physical activity could increase the risk of joint failure.
This thesis investigated this hypothesis.

In a systematic review we explored whether among people aged over 18 years, who underwent lower limb arthroplasty and had a minimum follow-up of one year, there was an increased risk of revision surgery amongst those undertaking work and non-work related heavy physical activity. We found limited evidence to address the question.

In a longitudinal study we followed-up two cohorts of hip and knee arthroplasty
recipients who were aged ≤65 years at the time of operation, and who were followed for a minimum of 5 years post-operation. Participants completed a questionnaire about work and leisure activities post-arthroplasty, symptoms and function since arthroplasty, and other relevant risk factors for joint failure.

An increased risk of revision of hip arthroplasty was found amongst those who reported kneeling/squatting post-operatively at work and those who were highly active at least once a week in their leisure time. Poor function at follow-up after both knee and hip arthroplasty was associated with heavy lifting at work. People needing to do heavy physical work were more likely to stop working post-operation because of a problem with their replaced hip or knee. All levels of leisure activity were beneficial for function after knee arthroplasty.

More research is needed to address this research question. Low and medium impact leisure activities should be encouraged as they are beneficial. However, we found some evidence to suggest that high impact activities increased the risk of hip revision.

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Identifiers

ORCID for Karen Walker-Bone: orcid.org/0000-0002-5992-1459

ORCID for Clare Harris: orcid.org/0000-0001-8037-566X

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