Are Activity Restrictions Necessary After Total Hip Arthroplasty: A Systematic Review

Background: There remains a lack of universal guidelines regarding the appropriate level of postoperative activity restrictions following total hip arthroplasty (THA). This systematic review aims to assess whether the liberalization of postoperative activity restrictions following THA impacts implant survivorship, return to sport, patient satisfaction, and functional health outcomes. Methods: A comprehensive search strategy was completed across PubMed, Scopus, and Web of Science databases using targeted keywords from January 1, 2010, to November 22, 2023. Inclusion criteria included randomized clinical trials, case-control, and cohort studies written in English. Data extraction focused on activity levels, rehabilitation protocols, implant survivorship, and physical and psychological outcomes. The primary search yielded 7420 articles, with 28 studies included after screening. Results: Return to sports outcomes demonstrated notable variability (20%-98.5%). Most studies reported improved survivorship in high-activity patients. High-activity participants had all-cause revision rates of 0.9%-8.57% and aseptic revision rates of 0.4%-5.7%. Low-activity participants had all-cause revision rates of 0.7%-3.4% and aseptic revision rates of 0.0%-2.1%. There was no clear association between activity level and dislocation rates. Positive associations between post-THA activities and improved mental health and patient satisfaction were observed. Conclusions: The current arthroplasty literature demonstrates that patients engaging in high-activity levels after THA exhibit similar or improved implant survivorship rates compared to patients participating in low-activity levels. However, high-quality prospective studies are needed to provide evidencebased guidelines. Patients should be encouraged to partake in activities at their own comfort levels with an understanding of their own limitations and risks. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).