| Summary: | Background: Younger and physically active patients demand a return to sport after total hip arthroplasty (THA). However, because of the risk of implant wear and loosening, high-impact activities are often not recommended. The current study evaluates predictive factors and revision rates in patients with higher activity levels. Methods: This retrospective study included 4152 hips in 3828 patients aged 45–75 that underwent primary THA for primary osteoarthritis between 2009 and 2019 with a minimum follow-up of 2 years. Pain and Lower Extremity Activity Scale (LEAS) were assessed before and 2 years after surgery. Activity was classified as low (LEAS 1–6), moderate (LEAS 7–13), or high (LEAS 14–18). Results: Pain and LEAS improved from preoperative to 2-years postoperative (<i>p</i> < 0.001). The activity level was low in 6.2%, moderate in 52.9%, and high in 40.9% of the patients. Younger age, lower BMI, ASA, and CCI, male sex, and higher preoperative LEAS correlated with higher activity at 2 years (<i>p</i> < 0.001). The predicted revision-free survival rates between the activity groups were better for more highly active patients (<i>p</i> < 0.001). Conclusions: High physical activity 2 years following THA, with participating in sports like jogging several times a week, did not increase the risk of revision surgery. THA patients should not be prevented from a highly active lifestyle.
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