Activity level a reliable indicator of orthopedic surgical outcomes

As much as any other physician, orthopedic surgeons want to keep patients safe from complications before, during and after any surgical event. If this involves the use of an orthopedic EMR system or a newly developed operating device, doctors are willing to use it to improve patients' outcomes. However, there are other ways to make sure patients are protected from adverse events during their recoveries.

According to a recent study conducted by researchers at Washington University and published in the Journal of the American Academy of Orthopaedic Surgeons, physicians can use patients' pre-surgical physical activity levels to predict how well they will fare under certain treatments. This will allow future post-operative recovery plans to be tailored to individuals' distinct characteristics to improve care for all.

Back to the future
Robert Brophy, an orthopedic surgeon at Washington University and the lead author of the study, conducted a literature review of the use of standardized scales of shoulder, hip, knee and ankle performance for pre-surgical orthopedic patients and their scores after the operations. However, no study before has looked at how the health of joints prior to surgery impacts the final outcomes.

Brophy found that each surgery location had identifiable predictors of success and failure that physicians should use to adapt their treatments accordingly.

  • Shoulder: Rotator cuff repairs were less likely to succeed in sedentary patients as well as those who believed that their treatments would not go well. Less active patients also did not improve at the same rate as their counterparts after nonsurgical rehabilitation sessions.
  • Hip: At both one and five years following surgery, high preoperative activity levels, low body mass indices and the male gender were all reliable indicators of positive long-term outcomes.
  • Knee: Anterior collateral ligament reconstructions were more successful on male patients with lower BMIs who demonstrated higher levels of physical athletic competition prior to surgery. 

The study also found that traumatic knee injuries in the athletic community – such as those experienced routinely by professional football players – may be linked to a higher incidence of knee osteoarthritis in the aging population of former athletes.

However, Brophy explained in a statement that though physicians can use the findings to inform their treatments to a more advanced degree, they should take care to truly look at each patient's individual attributes to form a personalized plan.

"In orthopedics, we want to restore function to take away pain and to help patients return to activity," Brophy said in a statement. "We are still learning about how to best use, quantify and measure activity levels to optimize prognostics and outcomes. There is not just one activity level variable … It depends on the population, the injury you are studying. We are making progress, and the progress varies depending on what you are looking at."

According to the U.S. Centers for Disease Control and Prevention, 719,000 knee replacement surgeries are performed every year, with hip replacements close behind at 332,000. Improving treatments for even a fraction of these patients will yield observable results in a short period of time.