Key words: total hip replacement, sports, activity, safety
Why is this study important?
Total hip replacement (THR) is one of the most common and successful surgeries worldwide for relieving hip arthritis. In recent decades, younger and active individuals are getting THR, and and they are increasingly hoping to continue high-level activities after surgery.
However, no definitive guidelines exist to inform surgeons and patients as to which activities are safe following THR. Recent survey studies have found that activity participation recommendations vary greatly among individual surgeons.
The SAFE-T study set out to answer this: Are certain types or intensities of activity linked to higher risks or worse outcomes after hip replacement? (1).
How did the study go about this?
The SAFE-T study was a prospective longitudinal parallel cohort study that followed 1,098 people who had a primary total hip replacement, in two groups:
- Group 1: From pre-operative to 5 years post-operative
- Group 2: From 5 to 10 years after surgery
Baseline demographic and surgical information was collected at the initial visit. Annual follow-up surveys were administered to quantify the type and amount of activity completed, presence of hip pain during activity, hip-related quality of life/patient-reported outcome measures, and occurrence of any complications or repeat hip surgeries.
Activity data were grouped into 6 categories (A to F) based on biomechanical studies measuring torque forces on the hip joint. Over 50 activities were grouped into these 6 categories, ranging from lowest intensity activities (category A – eg: aquafit, fishing, snorkelling) to the highest intensity activities (category F – eg: squash, tennis, basketball).
Duration of each activity (hrs/month), hip pain (yes/no), and other variables (eg: revision, complications, etc..) were used to construct regression models.
What did the study find?
Overall, 20.6% of all activity (hours/month) was in the highest intensity categories (E and F), completed by 11% of participants
The key finding is that subjects who engaged in high-intensity sports did not have higher rates of fractures, implant loosening, revision surgery, or worse quality of life compared to those doing lower-intensity activities.
There was no clear link between activity intensity and pain overall, but regression analysis showed that some specific activities (like snowboarding, squash, tennis, and backpacking) were moderately associated with hip pain during activity (r > 0.60). Others (like swimming, aquafit, snorkelling, home weights, sledding, and cross-country skiing) were linked with less pain
What are the key take-home points?
This study found that participation in high-intensity activity after THR does not appear to cause harm or increase the risk of complications over 10 years. Surgeons can caution patients that some high-impact activities might lead to more hip pain during activity, even if they don’t cause long-term problems.
References:
- Shah A, Whyne C, Kiss A on behalf of the SAFE-T investigators, et al. Safe Activity participation Following Elective Total hip replacement: the SAFE-T investigation, British Journal of Sports Medicine 2025;59:676-682.
Authors: Ajay Shah, Cari Whyne, Alexander Kiss, Hans Kreder, Dawit Gulta, Stephen Chen, Harman Chaudhry