After going through all the fuss to replace a joint, you want the best results, right? Well, here are a few tips to help you along the way. The focus is on physical activity (how much is too much?) and ways to prevent complications and revision (second) surgeries.
The information comes from a systematic review of 30 years' worth of research results (over a period from 1980 to 2010). All English-language studies of total joint replacements were gathered and reviewed. A special search was done to find studies that reported on sports or recreational activities after total joint surgery. Most of the surgeries were to replace the hip, knee, or shoulder.
Why is this information important? Because more and more young adults and active older adults are turning to joint replacement to alleviate pain from degenerative joint disease. And they intend to stay active after the surgery.
It is in their best interest to receive advice about level of activity and exercise. What's reasonable? What's too much? What's allowed? What's prohibited? How will the final results of the joint replacement be affected by physical activity and exercise? These are some of the issues addressed by this study.
Here's a list of the current guidelines available. Keep in mind, these are NOT the result of direct research studies comparing one patient group to another. They are the answers provided by surgeons filling out surveys and from consensus statements (agreements) made by groups of surgeons.
Everyone should stay as active as possible after joint replacement surgery.
Load and force through the joint (generated by movement) helps the bone grow around the implant and hold it in place better.
Some activities are recommended over others (e.g., walking, biking, or swimming rather than jogging, running, or football) because they place less load and strain on the hip and knee than others.
Activities that place the greatest peak force on the joint include golf, tennis, jogging, and running.
Premature wear and revision surgeries have been observed in cases of high joint load from high-impact activities.
Rates of implant loosening have been shown to be lower with physical activity.
Cemented joints may be a more important factor in the need for revision surgery than physical activity.
Surgeons agree there's a balance between enough activity to increase bone density and too much activity contributing to excessive wear and tear on implants. They agree that improved surgical techniques and better implant designs have allowed for greater physical activities without problems. They also report cases of active patients who fared far better than those who had an inactive lifestyle.
All patients can expect at least a 12-week period of rehab before pain, stiffness, and swelling are no longer present and interfering with motion and function. Many patients remain in rehab for up to five months or more. It is often six months before they can return to full sports participation.
Patients should not expect to take up challenging sports (e.g., skiing, roller derby, gymnastics, hockey) if they have not been engaged in these activities before surgery. And even those who have been involved in high-contact sports may be advised to stop participation due to the increased risk of high stress and load on the joint replacement.
In summary, "safe" levels of activity after total joint replacement have yet to be determined. Controlled studies to provide evidence are needed. Until clearer evidence-based guidelines are available, patients are encouraged to stay active while avoiding some of the higher impact activities.
Each patient is different and deserves an individual assessment. The surgeon will take into consideration the patient's age, general health, type of implant, patient goals and desires, and pre-operative level of activity. Level of involvement (e.g., physical fitness, sports recreation, or professional sports) remains a key factor as well.
Reference: Laura A. Vogel, BS, et al. Physical Activity After Total Joint Arthroplasty. In Sports Health. September/October 2011. Vol. 3. No. 5. Pp. 441-450.
