This week’s guest post comes courtesy of Bob Gorinski. Bob is the clinical director of Cardin & Miller Physical Therapy in Mechanicsburg. He is a Doctor of Physical Therapy, Certified Strength & Conditioning Specialist, Certified Pedorthist, and certified in the McKenzie Method of Mechanical Diagnosis and Therapy.

Needless to say, Bob knows a thing or two. However, he is also an all around great person, and not to mention very strong (see picture below). Today, he talks about his experience with a patient who had a total knee replacement, and what can be expected after surgery for a knee replacement. Fortunately, life does not end with a replaced knee! Read on to find out more…

Nature’s peace will flow into you as sunshine flows into trees. The winds will blow their own freshness into you, and the storms their energy, while cares will drop off like autumn leaves.

-John Muir, on hiking

While in my physical therapy office, “Jay” asked if it was okay to do squats for exercise. While technically a grandfather, he was no grandpa.

Now in his fifties, Jay suffered a traumatic sports related knee injury in his twenties and continued to be active through his adult life. This caused accelerated wear on his knee.

Despite having a knee replacement a few years ago, a quick physical assessment revealed that he possessed far better quality of motion than the average adult.

Prior to surgery, Jay loved being active. He consistently performed a resistance training routine with relatively heavy barbells and dumbbells. He hiked and bicycled, coached and played sports with his children. He lamented that he missed those days.

I asked him why he is not doing some of those activities.

After completing my assessment and watching him perform a few basic functional exercises, I saw no reason why he should refrain. As Jay performed a set of well controlled repetitions of an exercise we call “single leg hip hinge,” he mentioned the weight he was able to dead lift in his thirties and forties.

When I told him that’s it’s likely that he could build back close to that, he stared at me in disbelief. There was a twinkle in his eyes. I went on to explain that he had excellent general health and quality of movement, an extensive history with resistance training, and the weight that he mentioned was rather reasonable. So there was little reason why he should not try it. I would recommend attention to detail and a slow progression, of course.

Jay recalled what his previous therapists and doctors warned regarding twisting and high impact forces on the replacement. So we reviewed a basic biomechanical explanation of the dead lift. While there would be a relatively high load through his legs, the range of motion and impact at the knee would be minimal. We all place more impact and twisting force on our knees when walking down a flight of stairs or around a corner.

I mentioned that many people golf with knee replacements. Most doctors and therapists give golf a free pass simply out of convention, even though this demands some degree of impact and twisting force at the knee.

Jay repeated what he had heard regarding having a knee replaced at a relatively young age leaving more time for it to wear out. I reassured him with research evidence regarding longevity of the replacement. I also said that since joint replacements of today are even more resilient than those performed 10 to 25 years ago, it is widely believed that the prospects are better now.

I told Jay that I would take those chances (and by the years of arthritic development in my right hip, it is likely that someday I will), because there’s also the chance that something could happen, including grandkids growing up, a change of interest, and any variety of accidents that may prevent a person from getting much value in terms of quality of life from a replaced joint.

I believe that going for a hike outside, in the variable terrain of the woods, is living. I’ve experienced how a few challenging sets of dead lifts are nearly miraculous. I would risk a possible second knee surgery in exchange for a few occasions of being actively engaged with my kids. And I know that Jay holds the same values.

Don’t get me wrong. I’m not trying to claim that I know, for sure, whether or not Jay’s replaced knee will wear out.

It’s his call, of course. He may take every measure to protect and serve the replaced knee. He may partake of acceptable activities such as golfing and riding a recumbent bike. He may “sit this one out” when it comes time to play catch with his grandchildren.

And one day, he may go to the grave with an impeccably well preserved artificial knee.

Some Joint Replacement Facts:

According to the American Academy of Orthopedic Surgeons, 2.5 million Americans are living with an artificial hip, and 4.7 million Americans are living with an artificial knee.

The number of knee and hip replacement patients is growing dramatically, primarily due to a disproportionate growth in the rate of younger patients, and secondarily by overall population growth.

Over 90% of those who undergo joint replacement report a very good outcome.

Joint replacement patients who undergo post-surgical physical therapy have a shorter hospital stay and superior long-term functional outcomes.

The current recommendations of allowable activities following joint replacement are derived from surgeon surveys and preferences, not research evidence. Studies are needed to determine the extent that younger and active individuals can return to high impact and sports activities after joint replacement.

To read more from Bob, check out his blog Mental Reps

References:

Sports Participation Following Total Hip Arthroplasty International Journal of Sports Physical Therapy 2014 Nov;9(6):839-850

Trends in Total Hip Arthroplasty in the United States: The Shift to a Younger Demographic Presentation 542 –Adult Reconstruction Hip V, AAOS 2014 Annual Meeting.

The Changing Demographics of Total Joint Arthroplasty. Best Pract Res Clin Rheumatol 2012 Oct;26(5)637-47

Total Knee Replacement With and Without Patellar Resurfacing J Bone Joint Surg [Br]2008;90-B:43-9.

Outcome after rehabilitation for total joint replacement at IRF and SNF: a case-controlled comparison. Am J Phys Med Rehabil 2006; Jan85(1):1-5

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