Decline in habitual exercise after total hip arthroplasty during the COVID-19 pandemic: Who was most at risk?

Abstract

The impact of the COVID-19 pandemic on habitual exercise, physical function, and general condition in patients after total hip arthroplasty (THA) remains unclear. This study aimed to evaluate habitual exercise, self-reported changes, and associated factors, and to examine the vulnerability of postoperative THA patients to external environmental restriction that may limit habitual exercise, as exemplified by the COVID-19 pandemic. A postal survey was distributed to 2714 THA patients; 1413 responded (264 males, 1149 females; mean age 72 ± 10 years; BMI 23 ± 3.5 kg/m²; follow-up 5.6 ± 2.9 years). The questionnaire assessed habitual exercise, physical function (falls, walking speed, stair climbing), and general condition (strength, fatigue, motivation, sleep, weight, appetite). Patient-reported outcomes (Oxford Hip Score, UCLA-AS, EQ-5D) were also collected. Multivariable analyses were performed to identify factors associated with habitual exercise and with self-reported changes in physical function and general condition. Habitual exercise declined from 50 % before the pandemic to 41 % during the pandemic, with a continuation rate of 83 %. Most habitual exercise consisted of low-impact sports, with walking being the most common. Older age, female sex, higher BMI, and lower UCLA-AS were independent negative factors associated with the continuation of habitual exercise. About 30 % reported functional decline and 50 % reported deterioration in general condition. Discontinuation of exercise was significantly associated with both self-reported changes, whereas COVID-19 infection itself was not. Habitual exercise in THA patients decreased by nearly 20 % during the pandemic. Discontinuation was significantly associated with declines in function and general condition, suggesting the importance of developing targeted strategies for elderly and high-BMI patients.