Patients physically more active than ever before and after hip implantations

The proportion of patients physically active before and after a hip implantation increased in the last decade by 14%, Swiss researchers reported at the EFORT Congress in Istanbul. The sustainable success of hip replacements was confirmed in a recent long-term study which nevertheless cautioned against excessive physical activity.

Istanbul,  5   June  2013    –   Total   hip   implantations   provide   significant   and   enduring improvement  in  the  level  of  physical  activity  in  men  and  women  of  all  age  categories.  A study  confirming  this,  by  the  Geneva  University  Hospital  (Switzerland),  was  presented  at the 14th Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) in Istanbul. About 7,500 experts are currently discussing the latest developments in that specialty field. “Great expectations are commonly connected with hip implantations:   pain   should   disappear   and   mobility   should   return,”   explained   Dr   Anne Lübbeke-Wolff, author of the study. “However, some patients raise their expectations too high and are disappointed after the surgery. We therefore wanted to look more objectively at the course of physical activity before and after the intervention.” Specifically, the issue in question  was  whether,  in  the  last  ten  years,  physical  activity  of  patients  in  a  given  age category had changed before and after a hip implantation. The study examined the lifestyle of more than 2,900 patients before and approximately 1,600 patients after an  operation. The subjects were an average of 68 years old at the time of surgery and 56% were female.

More  active than  ever

The results are encouraging. While 68% of the subjects between 2000 and 2003 claimed to have maintained a sedentary lifestyle, the figure from 2007 to 2011 was only 54%, even though  they  were  in  the  same  age  group.  Total  hip  arthroplasty  patients  are  also  more active  than  ever  now.  Of  those  who  were  operated  on  between  2000  and  2003,  53% admitted five years after the intervention to being couch potatoes. The figure was only 39% for patients operated on from 2004 to 2011. “The study confirms that people do tend to exercise  more  than  they  did  just  a  few  years  ago,”  said  EFORT  President  Prof  Pierre Hoffmeyer (University Hospital of Geneva, Switzerland). The increase would be consistent with  activity  surveys  of  the  general  adult  Swiss  population.  International  studies  also confirm  the  trend  towards  a  moderate  increase  of  exercise.  “The  reasons  for  this  are complex. In any case, we can say that in regard to our cohort, patients increasingly are in better overall condition. This explains part of the higher level of activity. It also indicates an increasing awareness in the population of the importance of physical exercise. The fact is, there has been a 14% increase over the past decade in the proportion of patients that are physically active before and after hip implantation,” Prof Hoffmeyer said.

Sustaining mobility

The study also provides evidence that, to a large extent, surgery can help restore physical activity.  “Because  of  hip  disorders,  men  and  women  move  only  half  as  much  prior  to implantation than do those in healthy condition. An operation can still greatly improve the quality  of  life.  Even  ten  years  after  the  surgery,  the  degree  of  physical  activity  is  much higher  than  immediately  before  the  operation,  this  despite  the  advancing  age  of  the patients,”  Dr  Lübbeke-Wolff  reported.  At  any  point  in  time,  the  survey  noted,  women exercise less than men. “Theories are quite diverse about the relationship between gender differences and activity, ranging from the different way boys and girls play to traditional role models that still seem to prevail in the older generation. Men are more likely to find time for physical exercise, as well as for recreation, while women tend to be more concerned with household affairs,” the study’s author explained.

Caution: not  too  much  exercise

The aim of total hip implantations is to relieve pain and to restore a patient’s mobility as much as possible. Some patients become too active after the implantation, however, and thus shorten the life of the prosthesis. “It is very important in this regard that physicians treating patients conduct a detailed discussion with them about their previous sport, leisure and work activities. That includes asking them about their expectations and informing them about the kind of activities that are possible with a prosthesis. This should take place before the  operation  and  continue  during  the  follow-up  checks.  Patients  should  know  that,  on average,  the  operation  leads  to  a  significant  improvement  in  activity  compared  to  what could be achieved before the operation. Likewise, they should understand that they may not quite reach the level of activity enjoyed prior to the onset of arthrosis symptoms, especially not those patients under age 55,” Prof Hoffmeyer cautioned.

Hip  joints: Facts and  Figures

Osteoarthritis among the diseases in developed countries that most lead to disability. Worldwide, according to the WHO, 9.6% of men and 18% of women are affected. The implantation of an artificial hip joint has proven to be an effective and cost-efficient intervention for the treatment of severe cases. The operation is carried out mainly in people aged 60 or over. As OECD data shows, such interventions are sharply increasing, not least because of demographic trends. The number of hip implantations has increased in Denmark by 40% between 2000 and 2010, in Spain by 25% and in France by 10% – a development impacting  the  economics  of  health  care.  The  cost  of  a  hip  replacement  in  Europe  was estimated to average 7,300 Euros in 2009, which probably contributes to the enormous regional differences in the operations. Cyprus’ 15 hip implantations per 100,000 inhabitants was just one-tenth of the EU-24 average, which is 153 hip replacements per 100,000 population. Germany nearly doubles the EU average with 295 surgeries per 100,000 inhabitants. Age-standardised numbers change little in this ranking. Whether or not patients in Europe get a hip implantation, therefore, seems to depend less on medical needs than on economic conditions.


The   European   Federation   of   National   Associations   of   Orthopaedics   and   Traumatology (EFORT) is the umbrella organisation linking Europe´s national orthopaedic societies. EFORT was founded in  1991 in  the Italian Marentino. Today it  has 42 national member societies from 43 member countries and six associate scientific members.  

EFORT   is   a   non-profit   organisation.  The participating  societies aim at promoting the exchange  of  scientific  knowledge  and  experience  in  the  prevention  and  treatment  of diseases and injuries of the musculoskeletal system. EFORT organises European congresses, seminars, courses, forums and conferences. It also initiates and supports basic and clinical research.

Sources: EFORT Abstract 3595: Trends in patient physical activity before and after primary THA; How do we eat and exercise? Trends in nutrition and physical activity in Switzerland.: Swiss health observatory; 2010.; Knuth AG, Hallal  PC.  Temporal  trends  in  physical  activity:  a  systematic  review.  J  Phys  Act  Health  2009;  6(5):  548-59;  J Women Aging.  2005;17(1-2):55-70.  Gender  differences  in  physical  activity  and  walking  among  older  adults.;    OECD    (2012):    „Health  at  a  Glance“,  OECD    Publishing:

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