Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Case Western Reserve University School of Medicine, Cleveland, Ohio.
JBJS Rev. 2023 Aug 8;11(8). doi: 10.2106/JBJS.RVW.22.00249. eCollection 2023 Aug 1.
Return to work (RTW) and sports (RTS) are critical gauges to improvement among patients after total hip arthroplasty (THA). This study aimed to determine rates, timelines, and prognostic factors associated with RTW and RTS outcomes after primary THA.
A systematic review was conducted on MEDLINE, EMBASE, and CENTRAL databases with 57 studies meeting inclusion/exclusion criteria. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions and risk of bias in randomized trials (RoB2) tools. Meta-analysis and pooled analysis were conducted, with forest plots to summarize odds ratios and 95% confidence interval (CI).
The pooled RTW rate across all studies was 70% (95% CI, 68%-80%), with rates varying significantly from 11% to 100%. The mean time to RTW was 11.2 weeks (range 1-27). A time point analysis showed increasing RTW rates with a maximum rate at 2 years of 90%. Increased age (p < 0.001) and preoperative heavy labor (p = 0.005) were associated with lower RTW rates. The RTS rate ranged from 42% to 100%, with a pooled rate of 85% (95% CI, 74%-92%). The mean time to RTS was 16.1 weeks (range 8-26). The RTS ranged from 20% to 80% with a pooled proportion of 56% (95% CI, 42%-70%, I2 = 90%) for high-intensity sports and from 75% to 100% for low-intensity sports with a pooled proportion of 97% (95% CI, 83-99, I2 = 93%).
Most patients RTW and RTS after THA in an increasing manner as time passes with rates more than 85% after 1 year. These rates may be greatly affected by various factors, most notably age, the intensity of the sport, and the type of work performed. In general, young patients, low-demand work or sports can be resumed as soon as 4 to 6 weeks after surgery, but with increased restrictions as the intensity increases. This information should be used by practitioners to manage postoperative expectations and provide appropriate recommendations to patients.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
全髋关节置换术 (THA) 后，患者的工作恢复 (RTW) 和运动恢复 (RTS) 是改善的关键指标。本研究旨在确定与初次 THA 后 RTW 和 RTS 结果相关的发生率、时间框架和预后因素。
对 MEDLINE、EMBASE 和 CENTRAL 数据库进行系统综述，纳入符合纳入/排除标准的 57 项研究。使用干预措施非随机研究的偏倚风险 (RoB2) 工具和随机试验偏倚风险工具评估偏倚风险。进行了荟萃分析和汇总分析，使用森林图总结优势比和 95%置信区间 (CI)。
所有研究的总体 RTW 率为 70%（95%CI，68%-80%），从 11%到 100%差异显著。平均 RTW 时间为 11.2 周（范围 1-27 周）。时间点分析显示，RTW 率随时间增加，2 年时最大 RTW 率为 90%。较高的年龄（p<0.001）和术前重体力劳动（p=0.005）与较低的 RTW 率相关。RTS 率从 42%到 100%不等，总体 RTS 率为 85%（95%CI，74%-92%）。RTS 的平均时间为 16.1 周（范围 8-26 周）。RTS 率从 20%到 80%不等，高强度运动的汇总比例为 56%（95%CI，42%-70%，I2=90%），低强度运动的汇总比例为 97%（95%CI，83%-99%，I2=93%）。
大多数患者在 THA 后随着时间的推移逐渐恢复工作和运动，1 年后的恢复率超过 85%。这些比率可能受到多种因素的极大影响，尤其是年龄、运动强度和所从事工作的类型。一般来说，年轻患者、低需求工作或运动可以在手术后 4 至 6 周内恢复，但随着强度的增加，限制也会增加。从业者应利用这些信息管理术后预期并向患者提供适当的建议。
治疗性 III 级。有关证据水平的完整描述，请参见作者指南。
