Open Access Research article

Participation in physical activity in patients 1–4 years post total joint replacement in the Dominican Republic

Scott A Elman123*, Yan Dong1, Derek S Stenquist123, Roya Ghazinouri15, Luis Alcantara6, Jamie E Collins14, Carolyn Beagan5, Thomas S Thornhill123 and Jeffrey N Katz12378

Author Affiliations

1 Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA

2 Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA

3 Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA

4 Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA

5 Department of Rehabilitation Services, Physical Therapy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA

6 Department of Orthopedic Surgery, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic

7 Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA

8 Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA

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BMC Musculoskeletal Disorders 2014, 15:207  doi:10.1186/1471-2474-15-207

Published: 16 June 2014



To address both the growing burden of joint disease and the gaps in medical access in developing nations, medical relief organizations have begun to launch programs to perform total joint replacement (TJR) on resident populations in developing countries. One outcome of TJR of particular interest is physical activity (PA) since it is strongly linked to general health. This study evaluates the amount of postoperative participation in PA in low-income patients who received total joint replacement in the Dominican Republic and identifies preoperative predictors of postoperative PA level.


We used the Yale Physical Activity Survey (YPAS) to assess participation in postoperative PA 1–4 years following total knee or hip replacement. We compared the amount of aerobic PA reported by postoperative TJR patients with the levels of PA recommended by the CDC and WHO. We also analyzed preoperative determinants of postoperative participation in aerobic PA in bivariate and multivariate analyses.


64 patients out of 170 eligible subjects (52/128 TKR and 14/42 THR) who received TJR between 2009–2012 returned for an annual follow-up visit in 2013, with a mean treatment-to-follow-up time of 2.1 years. 43.3% of respondents met CDC/WHO criteria for sufficient participation in aerobic PA. Multivariate analyses including data from 56 individuals identified that patients who were both younger than 65 and at least two years postoperative had an adjusted mean activity dimensions summary index (ADSI) 22.9 points higher than patients who were 65 or older and one year postoperative. Patients who lived with friends or family had adjusted mean ADSI 17.2 points higher than patients living alone. Patients who had the most optimistic preoperative expectations of outcome had adjusted mean ADSI scores that were 19.8 points higher than those who were less optimistic.


The TJR patients in the Dominican cohort participate in less PA than recommended by the CDC/WHO. Additionally, several associations were identified that potentially affect PA in this population; specifically, participants who are older than 65, recently postoperative, less optimistic about postoperative outcomes and who live alone participate in less PA.

Knee arthroplasty; Hip arthroplasty; Osteoarthritis; Rheumatoid arthritis; Global health; Dominican Republic