SUMMER SCIENCE FRIDAY: JOINT redo's

Wilds of Colorado seen by train. taken by PKSenagore June 29, 2018. All rights reserved

“HOW LONG WILL MY HIP OR KNEE JOINT REPLACEMENT LAST?” is the question Harvard Health M.D. blogger Dr. Howard Schmerling attempts to answer.   It depends, he says, on your age at the time of surgery and how much you demand of the replacement afterward.
 
“During my training in the 1980’s and 1990’s” he says, “the teaching was that up to 90% or more of hip or knee replacements would last at least 10-15 years.” However, the combination of patient pre-habilitation before surgery, which involves shedding extra pounds and exercising, the use of better materials and surgical/anesthesia techniques, and improved post-surgical rehabilitation, might lead to even better numbers.   Hopefully replacement joints might last the rest of life, he surmised, in some patients. 
 
But “population based life-time risk data for implant revision” of replacement joints beyond 10-15 years hadn’t been examined. Until recently, stated researchers who undertook this task.  
 
Schmerling references the April 2017 study published in the British medical journal, Lancet, that provided the needed updated information about revision surgery, in UK patients that had undergone total hip replacement or total knee replacement. The abstract of the article included this summary (the full article is available free):

• Lifetime risk of requiring revision surgery OVER THE AGE OF 70 was 5%
• There was no difference between men and women
• Lifetime risk of requiring revision surgery YOUNGER THAN THE AGE OF 70, was up to 35% for men in their early 50s!
• The risk was 15% lower in women in the same age group
• The median time to revision for patients who had surgery younger than 60 was 4.4 years

 
The upshot is that doctors may recommend that patients put off joint replacement as long as possible, dealing with pain and less function, to help them get the most longevity from such surgery.
 
Why worry about the need for future revision at the time of the first surgery? Schmerling reminds readers that any major surgery carries a risk. He indicates there’s no guarantee surgery will be successful, and that it won’t lead to infection or loosening.  And that “’revision surgery’ is more technically difficult, recovery can take longer, and success rates may be lower than the first operations”.  
 
What he doesn’t address is the older age of the patient at the time of the second operation, 10, 15, or 30 years after the first.  Physically, and possibly mentally too, a revision is likely to be more difficult for the person undergoing the operation the second or even third time.
 
The referenced scientific article’s authors interpreted their findings, saying “our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group”. They recommended, “these data should be offered to patients as part of the shared decision making process.” 
 
Athletes might wish to pay close attention to the results of this study, even if not living in the United Kingdom.  Additional data from other countries may reveal population differences. Perhaps outcomes are better elsewhere in the world.  But the hope that a new joint will allow resumption of sport activity at levels similar or above that ‘enjoyed’ during the time damage was incurred, without need for a future operation,  seems unwarranted to Earned Runs. 
 
I have special interest in this report. Having learned in the past year I have mild to moderate osteoarthritis in my knees that has led to intermittent knee and calf pain, and then time off from running plus rehab work, I fear the eventual need for replacement surgery.  
 
I want to preserve ‘natural’ knee function and avoid invasive procedures.  After 40+ years of only running, the chance to train for and participate in a few more 5k, 10k , or even half marathon races holds relatively little appeal for me, when compared with the opportunity to continue to walk, golf, bike, paddleboard, and generally exercise on my own healthy legs.
 
I’ve heard people in their 50s at the gym say they were rehabbing after hip replacement to prepare for an upcoming half marathon.  Maybe word of this report will force a revision of their aspirations and expectations. There are so many alternate forms of exercise and sport to enjoy that there isn’t need to stick with one that resulted in joint replacement.  
 
And there’s the possibility that if surgery is put off by some younger-age patients contemplating it, pre-habilitation will lead to sufficient improvement that replacement can be delayed until lifelong benefit from only one operation can be expected.
 
RUN & MOVE HAPPY!
 
https://www.health.harvard.edu/blog/how-long-will-my-hip-or-knee-replacement-last-2018071914272
 
https://www.ncbi.nlm.nih.gov/pubmed/28209371
 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522532/
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