The conventional wisdom has it that the more active a patient is, the faster they’ll wear out their knee replacement. It certainly seems a reasonable assumption. Yet a new article published in The Knee suggests that a high level of physical activity does not increase the risk of revision surgery. Jim Newman looks at the impact of the research.
For our last holiday, my family went skiing. Our ski instructor was a 71-year-old who had been teaching novices for the best part of 40 years. Three years ago he’d had a knee replacement and yet here he was, skiing backwards, twisting and turning on a pin and generally putting everyone around him to shame.
Which started me thinking.
When we complete a total knee replacement, we can be extremely confident about a patient’s ability to resume the majority of activities they enjoyed pre-arthritis. But we tend to be a little less confident about the long-term effect of high impact activities on the implant. For that reason we might recommend delaying total (as opposed to partial) knee replacements for as long as possible so there’s less chance of wearing them out, because once a total knee replacement fails, you can’t have another one. The only option is a revision, which will never be as good as the original.
That’s why we might also suggest being a little careful when skiing, jumping or playing racket sports because of the additional stress forces and loads you put through your knee when engaging in such activities.
Yet a new study suggests we may be being over cautious.
Activity levels unrelated to risk of revision surgery?
The study, published in the latest edition of The Knee, finds that “a high physical activity level after total knee arthroplasty does not increase the risk of revision surgery during the first twelve years.”
This conclusion has been reached by combining the data from numerous patient studies and databases.
We probably need to take this with a small pinch of salt because the best form of research is one where you set out with a specific goal of proving something is true, rather than mashing together data designed for other purposes and using it to reach a conclusion. It’s also the case that we have no idea just how active the active people in these various studies were. We don’t know about their levels of fitness, their age or weight, their attitude to sporting risk and so on.
Yet the general point is clear: we probably need to worry less about the activities people may get up to with their new knees. We should have greater confidence in saying ‘yes’ to more activities. We shouldn’t attempt to warn patients against that game of tennis or that ski trip to Val Thorens because the evidence suggests their knees will be fine.
All of which should come as welcome news to patients who probably feel they’ve spent quite long enough avoiding or adapting their activities pre-replacement.
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