Sports after Joint Replacement
by Jose Fernando Syquia, MD, FPOAPain has traditionally been the primary reason why a patient would want a joint replacement surgery. Nowadays, however, a growing number of patients have become less tolerant of activity limitations and they are therefore choosing to have joint replacement to improve their function. Many of our patients expect to continue to participate in some form of sport after their surgery, especially if they have been active in that sport prior to their arthritic disease. Joint replacement surgeries are cost-effective medical treatments that provide substantial improvement in quality of life.
Regular exercise is beneficial to everyone. It helps reduce anxiety, depression, obesity, high blood pressure, coronary heart disease, diabetes mellitus and osteoporosis. It improves muscle strength, coordination, balance, endurance, and cardiovascular fitness. An increased life expectancy, coupled with good health and well-functioning joints, will enable the elderly to participate in various sporting activities.
Athletic activities, however, may pose special risks to patients with artificial joints. These include fractures, dislocation of the joint, wear of the articulating surfaces, and loosening of the implants. Active, high-demand patients may place their joints at risk for loosening and wear. Just imagine, with level walking, about 3.9 times the body weight is borne by the knee. This increases to about 8 times the body weight when walking downhill. On the other hand, the hip may experience forces in the range of 2.5 to 3.5 times the body weight during level walking. This increases by 43% with easy running. We can therefore appreciate that an increase in activity would translate to accelerated wear of the bearing surfaces of the artificial joint. This is why many surgeons have traditionally advised their patients to avoid high-impact activities in order to minimize wear of the implants. On the other hand, low impact activities are encouraged due to the benefits of exercise on the body.
Patients who participate in sports after a joint replacement surgery run the risk of traumatic complications such as dislocations, fractures around the prosthesis, and breakage of the prosthesis. Preoperative athletic activity is therefore an important factor that a surgeon will consider when advising a patient on what sport he could undertake after the surgery. Those who are skilled in a particular athletic activity have the best chance of safely resuming this activity. Those who are less skilled, or who have not done the activity before, are at increased risk of injury.
Loosening or breakage of the implant was a major concern with the first-generation prostheses. However, with newer prosthetic products, implant failure is a lot less common nowadays. There has also been a marked improvement in the design and fixation of implants over the past 30 years, leading to a decrease in loosening rates. Nevertheless, implant fixation may still be compromised by high levels of activity.
We do not discourage our patients from participating in reasonable athletic activities, especially when they prepare and train for them properly. However, it is important that they understand the risks involved. In general, low impact activities are allowed, intermediate impact activities are allowed with limitations and as long as the patient has previous experience with the sport, and high impact activities are discouraged.
In general, the following activities are allowed after a joint replacement: cycling, ballroom dancing, golf, swimming, walking, and hiking. If there is sufficient experience on the part of the patient, the following may be allowed: doubles tennis, weight lifting, skating, skiing, and aerobics. In general, the following sports should be discontinued: basketball, volleyball, soccer, jogging, and running. If in doubt, it is always best to consult with your surgeon before resuming or beginning any sport.