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How active can I be after a hip replacement?

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Hip Replacement Recovery

Many people have Total Hip Replacement (THR) – also called a Total Hip Arthroplasty; in Australia alone about 19,000 of these operations are carried out each year. Some Australian orthopaedic surgeons perform as many as 150 a year. The surgery does of course require the cessation of some activities for varying periods of time after the operation. For example, driving a car is usually prohibited for 6 weeks after surgery. In contrast, research indicates that walking, involving full weight bearing, can be recommended immediately after uncemented total hip arthroplastic surgeries. Immediately in this case means the first post-operative day. This early walking was carried out under the supervision of a physiotherapist.

A common question people have is to what extent can they resume, or start for the first time, a variety of activity types, such as cycling, jogging etc. They also wish to know how intensely they can participate in such activities after their surgery.

A matter of attitude?
Unfortunately, most patients do not adequately return within one year to normal levels of physical activity after a total hip replacement (and the same applies after a total knee replacement). The 'normal levels' were based on healthy individuals who have not had a hip replacement. It was concluded that: 'Improved perioperative strategies to instill behavioral change are required to narrow the gap between patient-perceived functional improvement and the actual amount of PA [physical activity] undertaken after THA and TKA [Total Hip Arthroplasty and Total Knee Arthroplasty].'1 It is easy to imagine that if a person has had their physical activity levels limited by pain due to hip pathology, then they may have become accustomed to limited activity. This would be especially likely if the limitation had been present for 5 or more years, as is often the case. In other words, they may have adopted an older person's attitude towards physical activity compared to peers of their own age. After the surgery, they may therefore require significant encouragement to look at themselves through younger eyes. There may be other good reasons for the above findings about decreased physical activity in the long term after a THR procedure. These may include patients not having adequately restored muscle strength and endurance after the operation. It may also be that their surgeon considered that the strength of their bone around the manufactured hip components would not tolerate certain activity types or activity intensities after the operation.

Sport recommendations
If the surgeon is confident of adequate bone strength and muscle strength and endurance after a THR, some patients may be pleasantly surprised as to what types of sporting activities they can enjoy after their surgery. For example, a survey of 28 orthopaedic surgeons from the Mayo Clinic, found that more than 75% of the surgeons recommended sports such as sailing, swimming laps, scuba diving, cycling, golfing, and bowling after a THR surgery. Sports that were not recommended by more than 75% of the surgeons after a total hip arthroplasty included running, waterskiing, football, baseball, basketball, hockey, handball, karate, soccer, and racquetball.

An Australian orthopaedic surgeon has stated that doubles tennis, horse riding and snow skiing on groomed blue runs are also acceptable, though noting that the latter two activities carry a risk of falling.

A matter of altitude? Mountain climbing
One activity that has not been extensively studied in the medical literature is mountain climbing. However, one case study reveals some encouraging possibility. This report concerns a 69 year old who had received cementless hip replacements on both right and left lower limbs about 8 years apart. The person had been an experienced high-altitude (i.e more than 6000 m) mountain climber. After the first operation he resumed alpine climbing (i.e more than 4) meters), 'as well as participate in difficult and strenuous climbs outside Europe',2 including: Mount Kilimanjaro - 5895 m, Mount Elbrus - 5642 m, and Mount Rolwaling - 7181 m trekking). Even more surprising is that after the second total hip arthroplasty, and of course intensive rehabilitation and training, he climbed two mountains that are higher than 6000 m.

Conclusion
It is very important that patients who have had a THR discuss with their surgeon what activities they can commence, and when they can commence them. The surgeon will be able to provide appropriate advice after the surgery, as they will at that stage have a very certain knowledge of the strength of the bones that anchor the manufactured components. The surgeon will also be able to comment on the tolerances of the manufactured components themselves. Patients will be able to increase their chances of participating in various sporting activities if they have worked hard to regain good muscle strength and endurance after their surgery.

References
1. Arnold JB, Walters JL, Ferrar KE, Physical Activity Increase After Total Hip or Knee Arthroplasty for Osteoarthritis? A Systematic Review. J Orthop Sports Phys Ther. 2016 Jun;46(6):431-42. doi: 1.2519/jospt.2016.6449. Epub 2016 Apr 26. http://www.ncbi.nlm.nih.gov/pubmed/27117726. Accessed 23/06/2016.

2. Peters P, Mountain sports and total hip arthroplasty: a case report and review of mountaineering with total hip arthroplasty. Wilderness Environ Med. 2003 Summer;14(2):106-11. http://www.ncbi.nlm.nih.gov/pubmed/?term=total+hip+arthroplasty+rehabilitation+mountain. Accessed 23/06/2016.

Jonathan Clerke

Principal Physiotherapist, IceFire Physiotherapy, Brendale (in the northern suburbs of Brisbane, beside Albany Creek, Eatons Hill, Warner and Strathpine)
08.05.2018

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