Which functional activities matter most to the patients during the first six months after hip or knee arthroplasty: a...

There is little understanding of which activities patients undergoing hip or knee arthroplasty prioritize at different time points after surgery. Thus, we conducted this study aimed to explore key functional activities from patients' perspectives at different timepoints during the first six months after hip or knee arthroplasty.

A survey was conducted at The Ottawa Hospital in Ottawa, Canada. Patients who underwent hip or knee arthroplasty due to osteoarthritis (OA) were recruited. This survey used a repeated cross-sectional design with four independent cohorts defined by time since surgery. A validated self-report questionnaire based on the activity and participation components of the International Classification of Functioning, Disability, and Health (ICF) core set for osteoarthritis was used. We classified functional activities as key if at least 75% of patients rated them as important and at least 15% reported difficulty performing them.

Among the 1170 patients invited to participate, 953 completed the questionnaire. This included 503 individuals who underwent hip arthroplasty and 450 who underwent knee arthroplasty, yielding response rates of 86.6% and 86.5%, respectively. The hip arthroplasty group had a mean age of 65 years (SD 10), with 51.1% female participants and a mean BMI of 28.3 (SD 5.6) kg/m². In the knee arthroplasty group, the mean age was 68 years (SD 9), 51.3% were female, and the mean BMI was 31.1 (SD 6.4) kg/m². Patients identified 24 key functional activities and 25 non-key functional activities within 2 weeks, at six, 13, and 26 weeks post-arthroplasty. Patients highlighted different key activities across various stages following arthroplasty, with a decline in the number of key activities over time. At 2 weeks, patients primarily prioritized basic mobility and essential self-care activities, such as getting in and out of bed, rolling over, sitting and standing, short-distance walking, and performing dressing and bathing tasks. By 6 weeks, priorities expanded to include more advanced daily activities, such as squatting, walking on different surfaces and longer distances, carrying objects, going up and down stairs, and completing domestic tasks like shopping and housework. At 13 weeks, priorities narrowed toward higher-level mobility, such as lifting heavy objects and long-distance walking. By 26 weeks, patients demonstrated a further narrowing of priorities as they regained independence; activities such as squatting, lifting heavy objects, walking longer distances and on different surfaces, and negotiating stairs were the most consistently important.

The study identified how patients' perspective on key activities changed over different recovery stages following arthroplasty. During the acute recovery phase, patients focused on simpler activities, progressing to more advanced activities. The findings revealed similar key activities between patients undergoing hip and knee arthroplasty. Understanding what matters most to patients enables clinicians to assess outcomes more accurately as well as adapt interventions that align with patients' needs to optimize time to recovery.