The Triathlete and Joint Replacement
“Some day I’ll wish upon a star, and wake up where the clouds are far behind me. Where troubles melt like lemon drops, away above the chimney tops, that’s where you’ll find me.” From, “Somewhere Over the Rainbow” (Or, it could be the unrealistic attitude of the triathlete with lower extremity arthritis when told that a joint replacement is in his/her future.)
“When I wear these knees out, I’ll just get ‘em replaced and race another ten years.” (Joe Triathlete)
In the words of Johnnie Carson, “Wrong barn breath.”
Looks like, between me and Dr. Dan Kirschner, you’re getting your fill of medical information. Maybe better too much than too little. The first triathlete I ever met doing Iron distance racing with an artificial joint in place was a gent about 35 years old who’d taken a bullet to the knee in Vietnam – and he had no choice. Winston Allen, from Florida, had his knee replaced a couple years ago and has his eye on Kona this fall racing at 81 or 82. A tall order for anyone of that “vintage” even with two knees which came from the original manufacturer. (Too old you’re thinking? Not so. Of the four men in the 80 – 84 year old age group in Kona this year, 3 of 4 finished! Impresses me!)
A replaced weight bearing joint, be it hip or knee, is a reasonable approximation of the original equipment. But to date, we’ve not figured out how to make them last indefinitely. That said, we’re getting better. Current expectations are a product life expectancy of about 20 years depending on in whom the joint gets installed. Consider the different demand loads placed on the prostheses by your average Medicare eligible 65 year old looking for a bridge foursome versus a 50 year old triathlete with premature arthritis and stated expectation of returning to the sport.
When I have my Orthopedic Surgeon hat on, I try to council patients to make what they have last as long as possible. This may require oral medications, injections of various substances designed to reduce inflammation and pain or increase the viscosity in the joint. It may require the dreaded activity modification (read reduce or stop running.) I say this, not to make one suffer but to consider the patients age, longevity prospects of the prosthesis and the potential for a revision (replacement of the replacement) and it’s possible complications. It’s not like we’re changing a light bulb here where not only is the second one just as good as the first, the only downside might be dropping it. The second total joint replacement is significantly harder to do than the initial one and the rate of complication rises. Infection, fracture, premature loosening, post op anemia, blood clots, the list goes on.
So, when you hear that you have some degree of arthritis in the knee or hip, see what long term plan you can adopt to put replacement as far into your future as possible. My friend Mike did IM Hawaii in 2004 and shortly after was diagnosed with significant hip joint arthritis. With a little weight loss and attention to detail, he was able to forestall a hip replacement for 6 years having just had the operation in May.
You might consider this a goal to shoot for. Or ask Mike, if you can catch him on his big BMW motorcycle. Buy you won’t catch him running.
High Heart Rate, Why Do I have It