Musculoskeletal Care of the Mature Patient
Sports and exercise after a total joint replacement
Disclaimer-Despite improvements in implant materials, design and prosthetic technology; implant fixation remains a critical factor limiting athletic activity after total joint arthroplasty in patients over age 65. For those under age 65, increased activity may result in cycling of the articular bearing surfaces and a risk of loosening from articular wear and particle production. Sports may increase the risk of dislocation; implant failure, and peri-prosthetic/prosthetic fracture.
Total Hip Replacement
Hip Resurfacing
Total Knee Replacement
Unicompartmental Knee Arthroplasty
The issue is not whether you can return to sports but whether you may participate in sports without affecting the outcome and survivorship of the prosthesis. As I review all relevant science on the subject of sports participation for patients who have undergone a hip or knee replacement, it becomes apparent that the largest group of artificial joint recipients who return to high level athletics are recipients of hip resurfacing or unicompartmental knee prostheses. It also becomes apparent that sports participation after joint replacement is very much impacted by your level of preoperative sports participation as well as your body mass index. In general, 95% of joint replacement surgeons impose no permanent restrictions on swimming, golf, walking on level surfaces, cycling on level surfaces and stair climbing. Five to six years of follow-up after a total joint replacement is too short to allow me to evaluate implant survivorship. What is scientifically documented is that you will have less pain and better motion and function after a new hip or a new knee. What is clinically observed is that the majority of patients can return to return to most sports after a new hip or knee. The remaining unproven scientific question is not whether you can or will be able to but whether you should? In 1973, I helped pioneer knee replacement surgery in the United States. Earlier during my residency training, I partook in the introduction of hip replacement surgery here in the Midwest. In 1979, I was a member of the team of three who introduced cementless joint replacement in the U.S. Until, the early 2000s, our preoperative informed consent emphasized prosthetic survivorship and minimizing those activities that might or could result in premature failure of the prosthesis. It seems that sports after total joints is the demand of the maturing athlete but also the result of medical advertising to promote market share. It’s not the length of you hospital stay or size of your scar but the survivorship of the prosthesis that must influence your ultimate choices.
