BACKGROUND: Patients often desire to participate in sports following total hip arthroplasty (THA) and total knee arthroplasty (TKA), but may be limited functionally and also socioeconomically. The purpose of this study is to investigate the sports participation rates in total joint arthroplasty (TJA) patients based on their Distressed Communities Index (DCI). METHODS: Patients who underwent TJA at our institution from 2015 to 2020 were surveyed on sports/physical activity participation before and after TJA. In total, 2,335 patients were surveyed: 780 (33.4%) underwent THA, 1,158 (49.6%) underwent TKA, and 397 (17.0%) underwent both THA and TKA. Patients were grouped based on their DCI score into either the prosperous (N = 1,126), comfortable (N = 634), or mid-tier/at-risk/distressed (N = 575) groups. Data were correlated with demographic and outcome scores. RESULTS: Participation rates were 85.3, 84.2, and 77.7% at 5 years before TJA in the prosperous, comfortable, and mid-tier/at-risk/distressed groups, respectively (P <
0.001). Participation rates were 74.2, 70.7, and 66.6%, at a mean of 4.0 years postoperatively (P = 0.004). For all three groups, the most popular sports were recreational walking, swimming, cycling, and golf, and there were significantly lower preoperative and postoperative levels of participation in these physical activities in the more distressed groups. Multivariate logistic regression showed that a DCI of 3 or higher significantly predicted the ability to participate in sports (P = 0.012). CONCLUSIONS: While sports participation rates are high in most TJA patients, participation is decreased compared to 5 years preoperatively, transitions to low-impact activities, and patients who are from more distressed communities report lower sports participation rates.