JOA - 2026-05-22 - Journal Article
Return to Sport and Exercise After Direct Anterior Approach Total Hip Arthroplasty: Minimum Five-Year Outcomes.
Mikula JD, Yanamala S, Kelly J, Rohdenburg JE, Couch CG, Taunton MJ, Hevesi M
Topics
Key Takeaway
At minimum 5-year follow-up after DAA THA, 90% of patients returned to sport within one year, but high-impact activity participation dropped from 24% to 10% postoperatively, driven largely by surgeon counseling (34%) rather than implant failure.
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Summary
This retrospective registry study surveyed 886 DAA THA patients to quantify RTS rates, timelines, and barriers at minimum 5-year follow-up. Ninety percent of those who returned to sport did so within one year; 74% returned fully and 16% with modifications. High-impact participation halved (24% to 10%) and running specifically dropped from 11% to 5%, with revision rates statistically equivalent between runners (4.5%) and non-runners (3.2%, P=0.651).
Key Limitation
The survey response rate is not reported, making it impossible to assess non-response bias—patients who experienced complications or stopped exercising may be systematically underrepresented, inflating favorable RTS rates.
Original Abstract
INTRODUCTION
Younger, more active patients increasingly undergo total hip arthroplasty (THA) and commonly inquire about expectations and timelines regarding return to sport (RTS) and exercise. The direct anterior approach (DAA) may facilitate faster recovery and decreased instability risk, but long-term RTS data are limited.
METHODS
A retrospective registry review identified all primary DAA THAs from 2010 and 2020. Patients who had less than five-year follow-up were excluded. Eligible patients completed a survey on pre- and postoperative sport participation, time to RTS, and potential factors limiting RTS. A total of 886 patients (466 women and 428 men) responded to the survey. Their mean age was 62 years (range, 28 to 93), and their mean body mass index was 29.0 (range, 17 to 49).
RESULTS
In the year prior to THA, 84% walked, 31% hiked, 27% cycled, and 11% ran. Postoperatively, 74% returned fully to prior activities and 16% returned with modifications, with 90% of these patients achieving RTS within one year. High-impact sport participation decreased from 24% preoperatively to 10% postoperatively, and running decreased from 11 to 5% (P < 0.001). Those who discontinued running most commonly cited surgeon advice (34%), fear of damaging the joint (21%), and pain (20%) as contributing factors for running cessation. Overall rates of revision were 4.5% for the running cohort and 3.2% for the non-running cohort (P = 0.651).
CONCLUSION
At a minimum five-year follow-up, most patients who underwent DAA THA successfully returned to sporting activities, typically within six months postoperatively. The majority resumed low-impact sports, while participation in high-impact activities declined. Patient counseling and fear of joint damage were common reasons for avoiding return to sport, despite mixed evidence suggesting increased risks of arthroplasty failure with high-level activities. Future prospective studies are warranted to better guide postoperative activity recommendations and clarify the long-term implications of sport participation after THA.