Sports and joint replacement: Patient perspective should be our priority

As the population ages, the number of joint replacement surgeries has increased exponentially. In the past, patient perceptions regarding the ability to return to high levels of activity and sports after joint replacement were often pessimistic, with many patients avoiding the procedure despite increasing pain and dysfunction due to perceived limitations after surgery.

Don Joy knee brace

Anthony A. Romeo MD, Grant H. Garcia MD, Healio Orthopedics Today May 2018

With improvements in surgical technique, bearing surfaces and device fixation, and the development of outpatient joint replacement, patient expectations have shifted to anticipate a rapid return to daily activities after surgery, followed by resumption of recreational and even competitive sports.

Personal bias
The boundaries for return to activities have typically been set by the surgeon. The origin and science behind the boundaries are vague, suggesting a common-sense approach that appreciates that an artificial joint made of plastic and metal has a finite number of total movements and tolerance to resistance activities, and, therefore, keeping these activities at a minimum would likely extend the longevity of the joint replacement. The concern that younger patients who are typically more active have less favorable outcomes, including longevity of the implant, has been used to support this concept.

The personal bias of the surgeon has more to do with these limitations than evidence-based research. Despite sophisticated methods to evaluate the results of joint replacement, the most important outcome for patients is the ability to return to their normal way of life. Patient satisfaction is closely correlated with the resumption of recreational and sports activities after joint replacement.

Return to normal way of life
Patients are returning to recreational activities and sport at a high rate – in some cases, such as anatomic total shoulder replacement, more than 90% of patients will confirm they are back to sports activities. Fitness activities have become more common activities after joint replacement as well.

Essentially, patients who participated in recreational activities before joint replacement surgery are highly likely to return to those activities and their overall satisfaction and perceived outcomes will be heavily weighted toward the success of their return to their normal way of life.

Unfortunately, many surgeons involved in arthroplasty surgery remain conservative in their recommendations of postoperative activity levels ignoring recent literature and imparting the “surgeon-centric” viewpoint on their patients. Historically, surveys of shoulder arthroplasty surgeons found implantation of a glenoid component was associated with recommendations severely limiting the activities allowed after surgery.

However, recent studies from Garcia and colleagues found both younger and older patient have a high rate of return to all levels of sport after any type of shoulder replacement, especially anatomic total shoulder replacement. Not only did patients report rates of return from 80% to 90%, but researchers also found excellent satisfaction and low complication rates at midterm follow.

Source Healio Orthopedics Today

Patient Activity Levels After Reverse Total Shoulder Arthroplasty: What Are Patients Doing? Garcia GH, Taylor SA, DePalma BJ, Mahony GT, Grawe BM4, Nguyen J, Dines JS, Dines DM, Warren RF, Craig EV2, Gulotta LV. Am J Sports Med. 2015 Nov;43(11):2816-21. doi: 10.1177/0363546515597673. Epub 2015 Aug 27.

Patient Satisfaction After Total Knee Arthroplasty: A Realistic or Imaginary Goal? Gibon E, Goodman MJ, Goodman SB. Orthop Clin North Am. 2017 Oct;48(4):421-431. doi: 10.1016/j.ocl.2017.06.001. Epub 2017 Jul 15.

Patient expectations and satisfaction concerning total knee arthroplasty, Duivenvoorden T, Verburg H, Verhaar JA, Bierma-Zeinstra SM, Reijman M. Ned Tijdschr Geneeskd. 2017;160(0):D534. [Article in Dutch]

The effect of expectation on satisfaction in total knee replacements: a systematic review, Timothy Barlow, Tamsyn Clark, Mark Dunbar, Andrew Metcalfe, and Damian Griffin. Springerplus. 2016; 5: 167. Published online 2016 Feb 24. doi: 10.1186/s40064-016-1804-6

Prospective quality of life assessment after hip and knee arthroplasty: short- and mid-term follow-up results,
Juan Pablo Martinez-Cano MD MS, Juan Pablo Herrera-Escobar MD, Ana Sofía Arango Gutierrez MD, Alfredo Sanchez Vergel, MD, and Alfredo Martinez-Rondanelli MD. Arthroplast Today. 2017 Jun; 3(2): 125–130.
Published online 2016 Nov 15. doi: 10.1016/j.artd.2016.09.008

Establishing Realistic Patient Expectations Following Total Knee Arthroplasty, Husain A Lee GC. J Am Acad Orthop Surg. 2015 Dec;23(12):707-13. doi: 10.5435/JAAOS-D-14-00049. Epub 2015 Oct 22.

A prospective study of the association of patient expectations with changes in health-related quality of life outcomes, following total joint replacement, Marta Gonzalez Saenz de Tejada, Antonio Escobar, Amaia Bilbao, Carmen Herrera-Espiñeira, Lidia García-Perez, Felipe Aizpuru, and Cristina Sarasqueta. BMC Musculoskelet Disord. 2014; 15: 248. Published online 2014 Jul 23. doi: 10.1186/1471-2474-15-248

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