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Return to sport following Total Hip Arthroplasty (THA): Do we all agree?
Journal of Science and Medicine in Sport 20S (2017) e32–e66
Contents lists available at ScienceDirect
Journal of Science and Medicine in Sport journal homepage: www.elsevier.com/locate/jsams
Thursday 13 October Posters
70 Return to sport following Total Hip Arthroplasty (THA): Do we all agree? Y. Kaplan Lerner Sports Center, Hebrew University, Israel Introduction: As younger, healthier patients are having THA, a greater emphasis is being placed on postoperative function, activity, and exercise. With recent advances in implant technology and surgical technique, the survival rates for modern prosthetic designs and patients with these high demands are promising. There is no current consensus on the safety of resuming to sport. The main concerns nevertheless are remaining instability, wear, loosening, and fracture. Objective: To provide a narrative literature review relating to returning to sporting activity following a THA. Methods: An electronic search was conducted up to September 2016, using medical subject headings and free-text words. Subjectspecific search was based on the terms “total hip arthroplasty”, “return to sport” and “exercise”. Results: T18 articles were found to be suitable. Only one was a prospective randomized study, comparing the type, intensity and frequency of sports activities performed after resurfacing hip arthroplasty vs. THA using a metal-on-metal bearing. All the rest were narrative reviews and expert opinion. One guideline consensus paper was published. Substantial limitations were observed in most of the publications, including small sample size, patient selection, trial quality, heterogeneity of outcome assessments, and potential sources of confounding variables not investigated. Discussion: Over the past 10–15 years, many aspects of THA have changed. The age group that has demonstrated the greatest increase in THA are patients between the ages of 45 and 64. Conflicts emerge with some studies that report lower survival rates for hip and knee arthroplasty in patients participating in high-impact sports. Conclusion: Each sport should be evaluated on its potential risk to a joint replacement, whether from the force of repetitive injury or the possibility of catastrophic failure. Likewise, a surgeon can use techniques, biomaterials, and implants that will maximize an athlete’s chance of success over time. There is a need for a longterm, high-quality, prospective randomized control trial that will compare low vs. high impact sports and their effect on the prostheses. Until then, definitive recommendations should be made http://dx.doi.org/10.1016/j.jsams.2017.01.092 1440-2440/
based on each patient’s expectations, goals and the surgeon’s past experience. http://dx.doi.org/10.1016/j.jsams.2017.01.093 71 Referent body weight values in over ground walking, over ground jogging, treadmill jogging, and elliptical exercise Y. Kaplan 1,∗ , E. Witwrouw 2 , M. Nyska 3 1
Physical Therapy and Sports Medicine Institute, Lerner Sports Center, Hebrew University, Israel 2 Department of Rehabilitation Sciences & Physiotherapy, Ghent University, Belgium 3 Department of Orthopedic Surgery, Meir Hospital, Israel Objectives: I. To evaluate average percentage body weight (APBW) values and weight-bearing distribution percentages (WBDP) between four common sports activities in a referent adult population. II. To suggest clinical implications. Design: Original research study. Setting: Lerner Sports Center, Hebrew University, Mount Scopus, Jerusalem, Israel. Participants: Seventy-five asymptomatic volunteers, mean age = 33.5 (19–72) years SD = 15.1, mean weight (kg) = 70.7 (43–113) SD = 14.1. Interventions: Four tests were conducted: (1) overground walking (OGW) over a 20 m distance, (2) overground jogging (OGJ) over a 20 m distance, Treadmill jogging (TJ) at a constant speed of 8.5 km/h for a 15-s interval and 4. Elliptical exercise (EE) for a 20 s period at a resistance and incline level of 10, and a steady pace within the range of 70–95 steps/min. Main outcome measure: The SmartstepTM weight-bearing gait analysis system. Results: The APBW value on the entire foot in OGW was 112% (SD = 15.57), in OGJ, 201% (SD = 31.24, in TJ, 175% (SD = 25.48) and in EE, 73% (SD = 13.8). Regarding WBDP, the swing phase in OGJ and TJ was significantly longer than the stance phase (p < 0.05). OGW resulted in significantly less swing phase compared to OGJ and TJ (p < 0.05). Conclusions: EE significantly reduces weight-bearing as compared to other common functional and sporting activities. These findings may assist the rehabilitation team when considering
Contents lists available at ScienceDirect
Journal of Science and Medicine in Sport journal homepage: www.elsevier.com/locate/jsams
Thursday 13 October Posters
70 Return to sport following Total Hip Arthroplasty (THA): Do we all agree? Y. Kaplan Lerner Sports Center, Hebrew University, Israel Introduction: As younger, healthier patients are having THA, a greater emphasis is being placed on postoperative function, activity, and exercise. With recent advances in implant technology and surgical technique, the survival rates for modern prosthetic designs and patients with these high demands are promising. There is no current consensus on the safety of resuming to sport. The main concerns nevertheless are remaining instability, wear, loosening, and fracture. Objective: To provide a narrative literature review relating to returning to sporting activity following a THA. Methods: An electronic search was conducted up to September 2016, using medical subject headings and free-text words. Subjectspecific search was based on the terms “total hip arthroplasty”, “return to sport” and “exercise”. Results: T18 articles were found to be suitable. Only one was a prospective randomized study, comparing the type, intensity and frequency of sports activities performed after resurfacing hip arthroplasty vs. THA using a metal-on-metal bearing. All the rest were narrative reviews and expert opinion. One guideline consensus paper was published. Substantial limitations were observed in most of the publications, including small sample size, patient selection, trial quality, heterogeneity of outcome assessments, and potential sources of confounding variables not investigated. Discussion: Over the past 10–15 years, many aspects of THA have changed. The age group that has demonstrated the greatest increase in THA are patients between the ages of 45 and 64. Conflicts emerge with some studies that report lower survival rates for hip and knee arthroplasty in patients participating in high-impact sports. Conclusion: Each sport should be evaluated on its potential risk to a joint replacement, whether from the force of repetitive injury or the possibility of catastrophic failure. Likewise, a surgeon can use techniques, biomaterials, and implants that will maximize an athlete’s chance of success over time. There is a need for a longterm, high-quality, prospective randomized control trial that will compare low vs. high impact sports and their effect on the prostheses. Until then, definitive recommendations should be made http://dx.doi.org/10.1016/j.jsams.2017.01.092 1440-2440/
based on each patient’s expectations, goals and the surgeon’s past experience. http://dx.doi.org/10.1016/j.jsams.2017.01.093 71 Referent body weight values in over ground walking, over ground jogging, treadmill jogging, and elliptical exercise Y. Kaplan 1,∗ , E. Witwrouw 2 , M. Nyska 3 1
Physical Therapy and Sports Medicine Institute, Lerner Sports Center, Hebrew University, Israel 2 Department of Rehabilitation Sciences & Physiotherapy, Ghent University, Belgium 3 Department of Orthopedic Surgery, Meir Hospital, Israel Objectives: I. To evaluate average percentage body weight (APBW) values and weight-bearing distribution percentages (WBDP) between four common sports activities in a referent adult population. II. To suggest clinical implications. Design: Original research study. Setting: Lerner Sports Center, Hebrew University, Mount Scopus, Jerusalem, Israel. Participants: Seventy-five asymptomatic volunteers, mean age = 33.5 (19–72) years SD = 15.1, mean weight (kg) = 70.7 (43–113) SD = 14.1. Interventions: Four tests were conducted: (1) overground walking (OGW) over a 20 m distance, (2) overground jogging (OGJ) over a 20 m distance, Treadmill jogging (TJ) at a constant speed of 8.5 km/h for a 15-s interval and 4. Elliptical exercise (EE) for a 20 s period at a resistance and incline level of 10, and a steady pace within the range of 70–95 steps/min. Main outcome measure: The SmartstepTM weight-bearing gait analysis system. Results: The APBW value on the entire foot in OGW was 112% (SD = 15.57), in OGJ, 201% (SD = 31.24, in TJ, 175% (SD = 25.48) and in EE, 73% (SD = 13.8). Regarding WBDP, the swing phase in OGJ and TJ was significantly longer than the stance phase (p < 0.05). OGW resulted in significantly less swing phase compared to OGJ and TJ (p < 0.05). Conclusions: EE significantly reduces weight-bearing as compared to other common functional and sporting activities. These findings may assist the rehabilitation team when considering