Commentary

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. 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

Anthony A. Romeo, MD
Anthony A. Romeo

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.

Grant H. Garcia, MD
Grant H. Garcia

Positive experience

Joint replacement surgery should be a positive life-altering experience, providing the opportunity for patients to return to their desired lifestyle. We should be thankful that our patient who return to these activities are participating in a lifestyle with many positive effects on overall health.

We should encourage a healthy lifestyle, including recreational sports, understanding this is likely to be associated with better outcomes from both the patient’s and surgeon’s perspective. Our goal should be to continue to research and innovate joint arthroplasty surgery to provide a lasting restoration of patients’ joint function at the level of activity patients desire for their life.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau and a consultant for Arthrex; does contracted research for Arthrex and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed. Garcia reports no relevant financial disclosures.

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. 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

Anthony A. Romeo, MD
Anthony A. Romeo

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.

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Grant H. Garcia, MD
Grant H. Garcia

Positive experience

Joint replacement surgery should be a positive life-altering experience, providing the opportunity for patients to return to their desired lifestyle. We should be thankful that our patient who return to these activities are participating in a lifestyle with many positive effects on overall health.

We should encourage a healthy lifestyle, including recreational sports, understanding this is likely to be associated with better outcomes from both the patient’s and surgeon’s perspective. Our goal should be to continue to research and innovate joint arthroplasty surgery to provide a lasting restoration of patients’ joint function at the level of activity patients desire for their life.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau and a consultant for Arthrex; does contracted research for Arthrex and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed. Garcia reports no relevant financial disclosures.