Why wait until you cannot stand it any longer?  By that time, years of physical fitness, sport participation, travel, and fun with the next generation may be lost.  The old advice for getting a total joint replacement was to wait until the pain was unbearable. “You’ll know when it’s time” used to be the saying. With further research, improvements in surgical techniques and advancements in materials, it may not be necessary to hold off so long.  According to the CDC, since the year 2000, the number of joint replacement surgeries tripled for people between the age of 45 and 55. People used to be told the joint would last 10-15 years, but now it is more likely 20-30 years. Surgeries are now less invasive and are increasingly performed on an outpatient basis.

Twenty five percent of us will have symptomatic hip or knee osteoarthritis at some point in life. Perhaps you are among the 25%.  You feel you’ve tried everything, including a good course of physical therapy, and the pain continues to impact your activity. You’re not old, but your joint makes you feel old. What is next? Are you a good candidate for a total joint replacement? What would you have to give up?  What would you gain?

“Can I return to my sport after a total joint?” is one of the biggest questions asked by younger individuals thinking about surgery.   Over the years, the advice given by surgeons has evolved. Traditionally, surgeons advised their patients to avoid high impact activities, such as running, downhill skiing and tennis. Now the answer depends on a lot of factors such as preoperative activity, current fitness level, BMI, bone quality, surgical approach and type of prosthesis. It is important to acknowledge that the arthritic joint likely caused atrophy of muscles around the joint and return to sports that require more of the body will take more time and work to return to than sports that require less of the body.  Though contact sports remain on the “not allowed” list, mature athletes do get back to most low, intermediate and high impact sports with the right rehabilitation strategies. It is important to fully rehabilitate sufficient range of motion, strength, proprioception and motor control to return to the movement demands, torques, and external forces of the desired sport.

But, what about dislocation?  What about wear and tear? Is there risk of fracture? What about loosening?  Yes, there are risks, but research is showing that the benefits may outweigh the risks in the younger population.  Prehabilitation, or physical therapy to optimize strength before surgery, also helps to improve outcomes. Quality of life, pain reduction, lower disease risk due to increased fitness may make it worth it.  The best place to start is with a conversation – with your physical therapist and a trusted surgeon.