The Triathlete, Arthritis and Joint Replacement 2018, Part 2, Racing?

"Not having a goal is more to be feared than not reaching one."
                                                  Chinese Proverb

Is this any truer than in triathlon where an entire year's work is frequently pointed at a single event?  This blog is part two of two where we see if replacement of a worn out, arthritic joint in a triathlete will let them "get back in the game" as we hear so often on television.

"Sure, I know several triathletes besides me who've had their knees replaced."    Chuck, Triathlete, TBC Coach            

4.5 Million Americans Living with Total Knee Replacements
TKR surgeries have more than doubled over past decade

A  study, funded by the U.S. National Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases, found that more than 4.5 million Americans are currently living with at least one TKR. This represents 4.7 percent of the population age 50 years or older – higher than the national rates for congestive heart failure and rheumatoid arthritis. In addition:
  • The prevalence of osteoarthritis is higher in women and so is TKR: 5.3 percent, compared to 4.1 percent in men.
  • Among persons age 60 to 69, 4.1 percent of men and 4.8 percent of women have a TKR; among those ages 70 to 79, 7.1 percent of men and 8.2 percent of women have had at least one knee replaced.
  • Ten percent of Americans age 80 and older are living with a TKR.

“The number of total knee replacements is growing drastically,” said Elena Losina, PhD, lead investigator and co-director of Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston, Mass. “We now have a lot of people living with TKR,” which may lead to substantial increases in the likelihood of revisions and complications, especially in younger patients.

Stephen Arata, PhD, at the University of Virginia preaches patience. "There are many with osteoarthritis of the knee that can put off something as complex as joint replacement if they simply step back for a moment and look at what they can do, not what they can't."  He thinks more would delay having the surgery if they could simply look at the picture of both today and well into the future.  "Many of the long term questions have yet to be answered." One definition of patience is "the capacity to endure waiting, or provocation without becoming angry or upset."  Arata's teachings are spot on for 2018.

The first triathlete I met with a total knee in place was during the marathon portion of the 1982 Ironman.  (In those days it was the Bud Light Ironman Triathlon World Championship.  It was the only one on earth.  There were 969 competitors in the race program, Scott Tinley wearing #1.  Guess what they served at the aid stations.) Not knowing any better, I was run/walking from 13 miles on in, with two other equally spent athletes. If you've never done it, there's more time than you realize to talk with your new found friends.  For some reason, the subject of my service in Vietnam came up and one of my walking mates admitted to a gun shot wound to the knee with subsequent joint replacement.  I was flabbergasted!  I'd been taught that joint replacement was for the bocci set at the nursing home and here's this guy next to me with one...who's probably going to beat me to the Ironman finish line!  Well, maybe.

As you'd suspect, I've learned of many in our sport with artificial joints since.

So how do you and your doctor make the decision about triathlon after surgery?  It's not an easy one and there's no right answer for everyone.  On one hand we have...the past. Two week hospitalization after surgery, traction and sometimes a delay in weight bearing, absolutely no sports noting that the literature is rife with joint replacement in the young athlete who was too frisky failing at 10 years requiring another, more difficult, operation.

Then, we have the present.  Short post operative stay, as little as over night, immediate full weight bearing, improved components and techniques, both full and half joint replacements, decades of experience on dealing with the stresses that an artificial joint sees.

Many currently feel that a strong muscular envelope around the hip or knee absorbs forces which may previously been born by the joint itself.  They also may contribute to assisting the tracking and joint function helping normalizing ones gait and joint function.  They go on to report that you'd try to run with normal/excellent form on forgiving surfaces with 2018 stress absorbing footwear.  You still understand that in some they're risking early revision surgery but others feel that to continue the sport they love at this point in their life, it's well worth the risk.

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