CHAPTER 101 • THE ATHLETE WITH A TOTAL JOINT REPLACEMENT 597•Patients who have achieved high levels of skill in ath-
letics have the best chance of safely resuming these
activities (Healy, Iorio, and Lemos, 2001).
- Preliminary evidence from Switzerland suggests that
individuals not regularly active, out of practice, or
inexperienced are at higher risk for sporting accidents
(Economic benefits, 2001). - Joint loads can be significantly increased for begin-
ners compared with experienced individuals.
DIFFERENCESBETWEENJOINTTYPES
(I.E., THA VS. TKA)
- When considering appropriate sporting activities for
total kneejoint replacement patients—one must con-
sider not only joint loads, but also the knee flexion
angle of the peak load. - In many total knee designs, the femoral and tibial
components are conforming near extension and non-
conforming in flexion (Kuster et al, 2000). Hence,
delamination and polyethylene destruction can occur
during activities like hiking or running where high
joint loads occur between 40°and 60°of knee flexion
(Kuster, 2002). - It is prudent to be more conservative after total knee
arthoplasty(TKA) than after total hip arthoplasty
(THA) when considering activities with high joint
loads in knee flexion. - When considering athletic activity for shoulder
arthroplasty patients, one must differentiate between
the dominant and nondominant arm, especially in
sports requiring throwing motions (Healy, Iorio, and
Lemos, 2001).
SURGICALFACTORS
•A comprehensive discussion of surgical factors is
beyond the scope of this chapter; however, some
important factors to consider include: (1) the impor-
tance of an anatomically and biomechanically accurate
joint reconstruction with a well-designed implant and a
properly balanced soft tissue or muscular envelope;
(2) the surgical approach (for example, lateral versus
posterolateral for THA); (3) fixation (cemented versus
uncemented); and (4) component selection materials
(ceramic versus polyethylene articular surface).
CONCLUSIONS
•Inthe absence of prospective randomized controlled
trials, physicians have a duty to use the currently
available scientific knowledge to educate their
patients regarding the risks and benefits of individual
athletic activities following joint replacement.
•Patients should not be discouraged from participating
in reasonable athletic activity when they prepare and
train for the activity, and when they understand the
risks.
•Ultimately, whether to engage in a particular sporting
activity after total joint replacement is up to each
individual patient. Patient must make the final deci-
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