Exercise recommendations after total joint replacement: a review of the current literature and proposal of scientifically based guidelines
Markus Kuster
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abstract
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This article presents a literature review of the current
recommendations regarding sports after total joint replacement and
also suggests scientifically based guidelines. Patients should be
encouraged to remain physically active for general health and also
for the quality of their bone. There is evidence that increased bone
quality will improve prosthesis fixation and decrease the incidence
of early loosening. To recommend a certain activity after total knee
or hip replacement, factors such as wear, joint load, intensity and
the type of prosthesis must be taken into account for each patient
and sport. It has been shown that the reduction of wear is one of
the main factors in improving long-term results after total joint
replacement. Wear is dependent on the load, the number of steps and
the material properties of total joint replacements. The most
important question is, whether a specific activity is performed for
exercise to obtain and maintain physical fitness or whether an
activity is recreational only. To maintain physical fitness an
endurance activity will be performed several times per week with
high intensity. Since load will influence the amount of wear
exponentially, only activities with low joint loads such as
swimming, cycling or possibly power walking should be recommended.
If an activity is carried out on a low intensity and therefore
recreational base, activities with higher joint loads such as skiing
or hiking can also be performed. It is unwise to start technically
demanding activities after total joint replacement, as the joint
loads and the risk for injuries are generally higher for these
activities in unskilled individuals. Finally, it is important to
distinguish between suitable activities following total knee and
total hip replacement. To recommend suitable physical activities
after total knee replacement, it is important to consider both the
load and the knee flexion angle of the peak load, while for total
hip replacement, which involves a ball and socket joint, the flexion
angle does not play an important role. During activities such as
hiking or jogging, high joint loads occur between 40 and 60 degrees
of knee flexion where many knee designs are not conforming and high
polyethylene inlay stress will occur. Regular jogging or hiking
produces high inlay stress with the danger of delamination and
polyethylene destruction for most current total knee prostheses.
Based on these design differences between hip and knee replacements
it is prudent to be more conservative after total knee arthroplasty
than after total hip arthroplasty for activities that exhibit high
joint loads in knee flexion.
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citation
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kuster m. Exercise recommendations after total joint replacement: a
review of the current literature and proposal of scientifically
based guidelines. Sports medicine (Auckland, N.Z.) 2002; 32:433-45.
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type
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journal paper/review (English)
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date of publishing
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0-2002
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journal title
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Sports medicine (Auckland, N.Z.) (32/7)
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ISSN print
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0112-1642
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pages
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433-45
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PubMed
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12015805
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