Intensive physical activity following total hip arthroplasty increased the revision risk after 15 years: a cohort study of 973 patients from the Geneva Arthroplasty Register

Background and purpose — Younger recipients of total hip arthroplasty (THA) highly prioritize returning to preoperative levels of physical activity (PA). Surgeons have tended to give cautious advice concerning high-impact sports participation, but there have been few long-term studies. The purpose of our study was to investigate the risk of revision arthroplasty in relation to postoperative PA levels. Methods — Patients registered in the Geneva Arthroplasty Register (GAR) who had elective THA when they were aged < 65 years were studied. Postoperative PA was collected prospectively 5-yearly using the UCLA activity scale. Cox proportional hazards models were used to estimate associations between PA and risk of revision THA. Results — Amongst 1,370 eligible subjects, median age at THA 58 years (interquartile range 51–61), UCLA scores were available for 973 (71%). During follow-up over 15 years, there were 79 revisions, giving a cumulative risk of 7.4% (95% confidence interval [CI] 5.8–9.4). After adjusting for covariates, we found an increased risk of revision for each unit increase in postoperative PA (HR 1.2, CI 1.1–1.4), and among people performing the most intensive PA (HR 2.7, CI 1.3–5.6) compared with those who were inactive. Conclusion — The overall risk of revision was small but intensive and moderate PA may be associated with an increased risk of revision.