West Virginia University, School of Medicine, Department of Orthopaedics, Morgantown, WV, USA.
Phys Sportsmed. 2011 Nov;39(4):70-9. doi: 10.3810/psm.2011.11.1941.
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common treatments for osteoarthritis (OA) with good-to-excellent outcomes. As the US population ages, rates of OA and THA/TKA will continue to rise. People with OA and THA/TKA are less active than those without arthritis or arthrosplasty, respectively. With the numerous documented health benefits obtained from physical activity, it is imperative from a public health perspective that patients are sufficiently active to maintain health after surgery. Increasing moderate-intensity physical activity is a safe, efficacious, and cost-effective mechanism for improving health and reducing health care costs in this population. The return to leisure/sporting activities after THA/TKA is not as well studied as other aspects of functional recovery. In particular, no evidence-based guidelines for physical activity after THA/TKA are available. Most recommendations have been derived from cross-sectional surveys of orthopedic surgeons. Based on the literature, the general consensus for recommendations appears to be to: 1) return to low- to moderate-intensity activities and no-, low-, or intermediate-impact activities within 3 to 6 months postoperatively, 2) discourage high-impact activities, 3) avoid high-contact athletic activities, and 4) educate rather than dissuade patients from resuming leisure/sporting activities. Sports medicine physicians are in an ideal position to counsel patients in regard to leading active lifestyles. The physician can evaluate and treat any remaining functional limitations postoperatively, as well as prescribe the appropriate dose (ie, type, intensity, frequency, and duration) of physical activity. The 2008 Physical Activity Guidelines for Americans can help guide physicians in prescribing the appropriate dose of activity. Finally, physicians can refer patients to evidence-based, community-delivered group exercise and/or behavioral change interventions that are approved by the Centers for Disease Control and Prevention for people with arthritis.
全髋关节置换术 (THA) 和全膝关节置换术 (TKA) 是治疗骨关节炎 (OA) 的常用方法，效果良好至极好。随着美国人口老龄化，OA 和 THA/TKA 的发病率将继续上升。患有 OA 和 THA/TKA 的人比没有关节炎或关节成形术的人活动量少。由于大量有文件记录的身体活动带来的健康益处，从公共卫生的角度来看，患者在手术后必须保持足够的活动量以维持健康。增加中等强度的身体活动是改善健康和降低该人群医疗保健成本的安全、有效且具有成本效益的机制。THA/TKA 后恢复休闲/运动活动的研究不如其他功能恢复方面充分。特别是，目前尚无 THA/TKA 后身体活动的循证指南。大多数建议都是从骨科医生的横断面调查中得出的。根据文献，对于建议的总体共识似乎是：1）在术后 3 至 6 个月内，恢复低至中等强度的活动和无、低或中冲击活动，2）不鼓励高冲击活动，3）避免高接触运动活动，以及 4）教育而不是劝阻患者恢复休闲/运动活动。运动医学医生在指导积极的生活方式方面处于理想的地位。医生可以评估和治疗术后任何剩余的功能限制，并开处适当剂量（即类型、强度、频率和持续时间）的身体活动。2008 年《美国人身体活动指南》可以帮助医生开处适当剂量的活动。最后，医生可以将患者转介给经过验证的、社区提供的团体运动和/或行为改变干预措施，这些干预措施得到疾病控制与预防中心的批准，适用于关节炎患者。
