Abstract
Introduction
Patients who undergo hip resurfacing, total hip arthroplasty (THA), and total knee arthroplasty (TKA) are frequently assessed post-operatively using objective scoring indices. A small yet significant percentage of these patients report pain and discomfort related to specific physical activities following surgery. The purpose of this study was to examine the types of activities which prove difficult for patients for each class of surgery, how important these activities are to the individual patients, and the demographic of patients who experience/report these limitations.
Methods
Four groups of subjects were enrolled in this study: (i) 111 hip resurfacing patients at an average of 14 months after resurfacing, (ii) 170 patients at an average of 16 months post-primary THA, (iii) 61 patients at an average of 12 months post-primary TKA, and (iv) 64 control subjects with no history of hip or knee surgery or pathology. Each participant completed a self-administered Hip Function Questionnaire, Knee Function Questionnaire, or Hip Resurfacing Questionnaire which assessed each subject's overall satisfaction and expectations following surgery. The questionnaires included a section with 58 physical activities and asked the patients to rate the activities based on frequency of participation, importance of the activity, and how much their knee or hip bothered them when performing the activity.
Results
The activities were scored for difficulty/bother on a scale of 1–5 with 5 being the most difficult, and scores of 4 or 5 were classified as “very difficult.” A population of patients rated activities as very difficult after surgery, including 33 (29.7%) resurfacing, 17 (10.0%) THA, and 32 (50.8%) TKA. The difficult activities varied based on the procedure, with many resurfacing patients reporting trouble with kneeling, squatting, and running; THA patients reporting trouble with squatting, sexual activity, and stretching; and TKA patients reporting trouble with gardening, kneeling, and squatting. The importance of the activities were also scored on a 1–5 scale with 5 being very important to the patient. The average importance scores for the difficult activities were 3.88 for resurfacing patients, 3.35 for THA patients, and 3.58 for THA patients. The demographic of patients who reported activities as difficult varied based on the type of surgery. After hip resurfacing 19.0% (4/21) of female patients reported activities as being difficult compared to 34.5% (29/84) of male patients; 13.6% (11/81) of female THA patients reported compared to 6.0% (5/84) of males, and 48.6% (18/37) of female TKA patients reported compared to 54.2% (13/24) of males.
Conclusions
A significant portion of patients experience great difficulty with certain physical activities following hip resurfacing, TKA, and THA procedures. The frequency and types of difficult activities reported vary based on the surgery, with TKA patients reporting with the highest frequency and THA patients reporting with the lowest frequency. The gender of the patient appears to play a role in whether certain activities are difficult or not, with female patients more likely to report after THA and TKA, and male patients more likely to report after hip resurfacing.
