title: Habitual physical activity and sports participation after total ankle arthroplasty.
abstract: BACKGROUND
  There is a lack of detailed information about habitual physical activity levels and the sports participation of patients after total ankle arthroplasty.
  
  
  OBJECTIVE
  The proportion of sports active patients increases after total ankle arthroplasty, and the majority of patients will meet current recommendations for health-enhancing physical activity.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The authors assessed the pre- and postoperative participation in sports and recreational activities of 101 patients at a mean of 3.7 years after total ankle arthroplasty. Activity levels were determined with use of the University of California at Los Angeles (UCLA) activity scale. The International Physical Activity Questionnaire (IPAQ) was used to quantify habitual physical activity levels and to calculate the proportion of patients meeting current guidelines for health-enhancing physical activity. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used as the clinical outcome measure. Radiographs were studied for tibial and talar radiolucencies, and any association between radiolucencies, activity levels, and sports participation was determined.
  
  
  RESULTS
  Preoperatively, 62.4% of the patients were active in sports; 66.3% were active after surgery (P=.56). The patients were active in 3.0 +/- 1.8 different sports and recreational activities preoperatively and in 3.0 +/- 1.6 activities after surgery (P =1.0). The sports frequency remained unchanged, with 2.0 +/- 1.6 sessions per week before total ankle arthroplasty and 2.3 +/- 1.7 sessions per week postoperatively (P=.19). Overall, the patients were active in sports and recreation for 3.9 +/- 3.8 hours per week pre-operatively, and for 4.7 +/- 3.9 hours per week after surgery (P=.14). The most common disciplines after total ankle arthroplasty were swimming, cycling, and fitness/weight training. Sixty-five percent of the patients stated that surgery had improved their sports ability. The UCLA activity levels increased significantly from 4.3 +/- 2.2 to 6.2 +/- 1.6 (P<.001); AOFAS scores also improved significantly from 45.5 +/- 16.6 to 84.3 +/- 13.3 (P<.001). Patients suffering from posttraumatic ankle osteoarthritis were less satisfied with surgery than those with primary or inflammatory ankle osteoarthritis. Seventy-nine percent of the patients met the current guidelines for health-enhancing physical activity according to the IPAQ. Neither sports participation nor activity levels were associated with the presence of periprosthetic radiolucencies.
  
  
  CONCLUSIONS
  Two-thirds of the patients were active in sports after total ankle arthroplasty, and the majority of the patients met current health-enhancing physical activity recommendations. The clinical outcome as determined by AOFAS scores and the patient satisfaction were favorable. The present study found no association between sports participation, increased physical activity levels, and the appearance of periprosthetic radiolucencies 3.7 years after total ankle arthroplasty. However, these results have to be confirmed after longer follow-up, in particular of those patients regularly participating in sports with higher impact.
authors.affiliation: Department of Orthopaedic Surgery, Foot and Ankle Center, Schulthess Clinic, Zurich, Switzerland. florian.naal@gmail.com
authors.forename: Florian D
authors.initials: FD
authors.lastname: Naal
authors.forename: Franco M
authors.initials: FM
authors.lastname: Impellizzeri
authors.forename: Markus
authors.initials: M
authors.lastname: Loibl
authors.forename: Martin
authors.initials: M
authors.lastname: Huber
authors.forename: Pascal F
authors.initials: PF
authors.lastname: Rippstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001178:Arthroplasty / Q000379:methods*; D012090:Cumulative Trauma Disorders / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011859:Radiography; D013177:Sports; D011795:Surveys and Questionnaires; D013557:Switzerland; D016896:Treatment Outcome; D055815:Young Adult