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1st May

2012

Return to Athletic Activities After Hip and Knee Replacement Surgery

As the baby boomers age, yet often desire to keep an active and athletic lifestyle, the number of cases of painful osteoarthritis in joints such as the hip and knee, have escalated. As a result, more and younger people are demanding joint replacements throughout the US and in Europe, in an effort to keep the same lifestyle.

There are many benefits of athletic activity following total joint replacements, but also risks such as repetitive loading and wear of the joint causing loosening of the implant, or in the more acute stage fractures surrounding the prosthesis. Therefore, high impact activities are typically recommended against.

Several studies have shown no negative effects on total hip replacements after athletic participation, even at 10-year-follow-up, and have even shown lower rates of loosening of the implant, compared to sedentary people. Proponents of athletics after hip replacement argue that exercise induced loading of bone and increased muscle coordination, endurance and strength outweigh the negative effect of increased joint surface wear. A few studies have claimed greater revision rates due to joint failure in younger and more active patients.

Published results of return to athletic participation after total knee replacement have been more limited, and not as encouraging. Whereas excellent results have been shown long-term in patients returning to low impact activities, only 20-25% have been shown to return to high level activities, however typically without high-impact. A significantly greater number of hip replacement patients have been shown to return to athletics, as compared to after total knee replacement, however in general, total joint replacement can allow a significant increase of sports participation long-term.

Based on available outcome studies, and research looking at mechanical force measurements, and wear of implants, certain guidelines have been provided.

Low impact activities are encouraged for all patients, including walking, swimming, golf, treadmill, stationary bicycle and elliptical machines.

With monitoring, a person with good balance can typically also return to bicycling, speed walking, cross-country skiing, dancing, Pilates and rowing.

A select group of well conditioned people with previous experience with these sports, may be able to get back to tennis, hiking, downhill skiing and snowboarding, weight training, ice skating, rollerblading, and low-impact aerobic exercise.

High-impact athletics and contact sports have been strongly discouraged for most total joint replacement patients. Such exercise would include running, racquetball, high-impact aerobic exercise, most ball sports, martial arts and rock climbing.

Past studies have also shown remaining muscle weakness 1-2 years after total joint replacement surgery, and sufficient rehabilitation is therefore encouraged before returning to sports activities, to restore normal joint mechanics and postural control, and protect the implant and surrounding soft tissues during activities.

There are several factors to take into consideration, when counseling patients regarding safe athletic participation. Studies have shown that people, who are sedentary prior to joint replacement, seldom return to athletics after the surgery. Certain surgical techniques may allow for faster recovery, but according to researchers, no studies to date have shown improved long term ability to participate in sports activities following any specific hip or knee replacement approach. Studies have shown a greater risk of failure of cemented acetabular components, or socket cup in the hip, in younger, more active individuals. Certain materials may show lower wear and improved longevity, but may cause an increased fracture risk if exposed to impact activities. The demands of a particular sport must be considered, including impact or torsional forces on the prosthesis, and the risk of heavy contact or fall.

More limited joint replacement procedures have become more popular, in particular for younger people, including hip resurfacing replacement and unicondylar knee replacement (partial replacement). Studies have not specifically addressed the long-term survival of hip resurfacing procedures after return to athletic activities; however a few studies have reported successful return to sports activities in 90% of cases at 2-5 years following surgery. When comparing return to athletic participation after unicondylar knee replacement versus total knee replacement, one study showed that short-term follow up at 1.5 years after surgery favored the unicondylar knee replacement procedure.

With wishes for continued good health,

Gunnar

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