Abstract
Background
Lower limb arthroplasty is a highly successful orthopaedic procedure, but the prosthesis may fail over time, necessitating revision surgery. Recognised risk factors for revision include obesity and metal on metal devices, but it is less clear whether heavy physical activity, at work or during leisure time, can impact the survival of the replaced joint. We undertook a systematic review to explore this question.
Methods
Original studies published 1985-2017 reporting risk factors for hip or knee revision arthroplasty (excluding revision for infection) in people aged over 18 years and with ≥1 year follow-up post-arthroplasty were identified from Medline, Embase, and Scopus. The search yielded 10,361 results, amongst which 12 addressed the research question.
Results
Out of the 12 studies, 9 were concerned with failure of primary hip arthroplasty and only 3 with failure of primary knee arthroplasty. We found extraordinary variation in the methods used to quantify exposure to both occupational and leisure-time physical activity. As a result, the data were poorly comparable, and some studies reported that post-operative physical exposures were beneficial for joint survival whilst others reported that they were deleterious. Many studies only assessed the relevant exposures before the operation, which may limit the relevance to post-arthroplasty physical activities. Overall, we found some (variable quality) evidence suggesting that agriculture/farming and industry/engineering/construction work and, in women, health services work may increase the risk of revision. Likewise, there was conflicting and moderate quality evidence that exposure to high-intensity leisure-time activities may increase the risk of failure.
Conclusion
As increasing numbers of arthroplasties are performed at younger ages, and people are encouraged to work to older ages, more evidence is urgently needed about returning to some types of work and any future risk of joint failure. This is particularly important for advising people doing manual and emergency services/military type work. Leisure-time physical activity is good for health and high-quality evidence is needed here to inform if specific types of sport should be avoided, particularly for knee patients.
Disclosures
E. Zaballa Lasala None. C. Harris None. K. Walker-Bone None.
P69 Occupational and leisure activities as a risk factor for hip and knee revision surgery