Sports after Total Joint Replacement
Section snippets
Hip replacement
Hip replacement surgery has been the proving ground for technology, including new crosslinked wear-resistant plastics, durable less brittle ceramics, and precise micron-level metallurgy. Old avenues of thought that failed in the past are being reexplored, reinvented, and revisited. With our new technology and advances in manufacturing blending with our knowledge of past failures from the last 20 years, we hope to have three effective options for wear resistant bearing surfaces. The traditional
Knee replacement
Numerous developments and improved partial replacements have emerged in recent years. Just as we are revisiting old ideas in hip replacement, partial knee replacements have experienced an intensive resurgence. The smaller incision and quick recovery compared with total replacement make these devices quite marketable. More recently, the limited incision has been applied to total replacements in an effort to improve recovery time and reduce the intensive physical therapy necessary in the
Shoulder replacement
Shoulder arthroplasty has been an area of recent improvements in implant designs. Near custom implants and recreation of anatomic orientation has become possible with several designs of implants. Hemiarthroplasty and total shoulder replacements have each demonstrated excellent success in the correct clinical setting. Glenoid replacement has been the primary component of concern regarding possible loosening while humeral fixation with either cement or pressfit fixation has proven to be
Elbow replacement
Constrained or linked hinged elbow arthroplasty remains the standard replacement for the elbow such as the Coonrad-Morrey. Recovery to the level of advanced participation in sports is rare, and can lead to loosening due to the constrained nature of the implants. Limiting activities to those of daily living is best for most patients, as anecdotal evidence suggests that elevated levels of function and forces leads to early loosening of the implants [21], [22].
Ankle replacement
Recent advances in ankle replacement designs have led to improved results and lower failure rates. However, these improved results are similar to the early results with hip and knee replacements that were initially successful due in part to their use in the low demand population of the elderly less active patient. The newer designs are entering the early (3–8 year) stage results with surprisingly low loosening and failure rates [23]. Time and further advances will hopefully allow a more normal
Discussion
Literature reviews on sport participation after replacement surgery are limited in number and scope, and based more on personal opinion rather than prospective studies. Lower impact exercise seems better tolerated by patients, and in theory, is less likely to create an environment for loosening whether it is secondary to wear debris osteolysis or impact-related loosening or a combination of both. As impact loading and torsional loading escalate, the relative risk associated with an activity
Summary
Today's patients require additional guidance in their expectations after replacement surgery. Failure rates for shoulder, hip, and knee, replacements across most studies are approximately 0.5% to 1% per year, including infection, loosening, and wear of the parts. Elbow and ankle replacements will likely require more restrictions and have slightly higher revision rates.
As the aging population of “weekend warriors” tries to maintain their fitness craze of the seventies and eighties, another
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