I know this is the time, this is the time to be more than a
name, or face in the crowd, I know this is the time,
this is the time of my life." David Cook, American Idol
Been told you need to have a joint replacement?
Well, this will make a major change in your choices of sports. I talked with one of the companies that manufactures joint replacement products to see if there'd been any major changes in the recommendations for those who've undergone knee or hip replacement. I'm sad to report that there have not. Joint replacement is the end resort when a patient has unrelenting pain accompanying arthritis of a joint. The orthopedic community has improved the current artificial joints to where we now feel that they should last approximately 20 years depending on the age of the patient, weight, activity choices, etc. The operation is performed as an in-patient, under anesthesia, and a hospital stay of 2-3 days is common. Frequently you are encouraged to put all your weight on the operated limb from day 1. Potential complications include bleeding, blood clots, infection, surgical failure to name just a few.
Once fully healed, you will be encouraged to swim, bike, dance, stretch, etc. You may note that participation in triathlons is not found on the list and for good reason. One's goal is to get the joint to last as long as possible, potentially for the rest of your life. Re-operating on an artificial hip or knee is significantly harder than the initial procedure, the results less certain and the possibility of complication higher. That said, one recent study found that 80% of hip replacements in patients under 65 were still working well at 15 years while 94% of those over 65 had the same success. It's felt that risk factors that shorten the longevity of the prosthesis include weight, age as just noted with being under 65 a risk factor, choice of activities (even though some may not hurt they may over stress the new joint), avoiding complications like fracture around the prosthesis, infection, dislocation, etc.
When I earned my MBA before med school, in Marketing class we learned about early adopters, a sub group of folks who don't mind a little increased risk or expense if they can have the latest and greatest products around. Sound like anyone you know? Like most of the triathlon community? You bet. But, in this situation, it may be best to work carefully with your surgeon as the newest product that may be well intentioned, designed to last a lifetime in all, may not. One of these is called hip "resurfacing" in which less bone is removed and a cap placed over the head of the femur. It's specifically marketed to the younger patient. Floyd Landis had one in 2006.
Although we as physicians think we have the answers to longevity through research, one of the manufacturers is encouraging real world answers to patients who have one of their joints implanted. in other words, regardless what what they were advised to do, what have they really done and has it affected the joint wear? One example of this was a woman I saw on Slowtwitch, several years out from a hip replacement, who did iron distance racing. Or a gent I met in my first Ironman in 1982 with a total knee replacement who'd suffered a gunshot wound to the knee as a serviceman in Vietnam. These folks and others like them will continue to contribute to joint replacement research, hopefully with success galore.
Images 2, 3 Google Images