Risks after THA or TKA Risks after THA or TKA

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Thread: Risks after THA or TKA

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    Default Risks after THA or TKA

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    I read the article posted on this site last year on training after joint replacement titled “Training and the Artificial Joint” by John Petrizzo, but had a question about the the last sentence: “However, due to the lack of evidence to supports its use, I can only suggest implementing resistance training with patients and clients who have a good understanding of the risks and benefits involved, and are accepting of any potentially negative consequences that may arise.” My question are what are the risks and potential consequences?

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    For risks, would you prefer actual risks or would you prefer medical community CYA risks?

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    Actual

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    The "lack of evidence" is simply due to lack of studies being performed that demonstrate the safety and efficacy of strength training after THA/TKA. If you can imagine, coming up with a study, funding it, getting it approved through an institutional review board, finding an ample number of subjects, etc all pose a large hurdle to overcome to get quality research evidence. Even then, when you do get a study testing progressive resistance training S/P THA/TKA, the results get watered down by the researchers putting together exceptionally poor methods because their understanding of progressive resistance training is different than what we understand it to be.

    The potential risks of actual strength training after THA/TKA would be: risk of failure of the prosthesis (either by failure of the bone to which it is fixated to, or by failure of the hardware itself), risk of acute injury due to poor proprioception (think crush injuries, musculoskeletal injuries, back injuries), risk of accelerated wear of the prosthesis / breakdown of the prosthesis.....

    In all honesty, that covers most of it. I think the vast majority of clinicians over-emphasize the last risk (accelerated wear of the prosthesis or breakdown of the prosthesis) when we work with S/P THA/TKA clients / patients. I, personally and professionally, think that the risk of accelerated wear is minimal simply because the joint forces during routine activities is just as high, if not higher, than it is during progressive resistance training. Also, if we over-emphasize the risk to the joint prosthesis, we somehow have narrowed your worth as a person to the prosthesis. The prosthesis is all that matters when we say things like that, and the biggest risk of not training is all the myriad of health conditions that occur in individuals who do not exercise or train often enough.

    If I had either a THA/TKA, even if I had bilateral THA/TKAs, I would not hesitate to go back to barbell training. It may look a bit different than prior to the joint replacements, but I am not sold on these risks enough to prevent myself from doing it.

  5. #5
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    Thank you. As to the point that health care providers worry only about the life of the implant, I can certainly testify to; while interviewing surgeons for my needed bilateral THA it was more then hinted at by a few surgeons that I should really just swim or walk for exercise, which begs the question if joint replacement surgery is meant to improve the patient’s quality of life, yet the health provider is also saying that you can not return to actives that gave said person happiness (and that is leaving aside the enormous physiological benefits of training) what the bloody hell is the point of doing the surgery if there is little pain, but almost complete loss of any ROM (which is my case). I sink like a stone in the pool, and walking only gets my heart rate up a bit.

  6. #6
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    The "lack of evidence" is simply due to lack of studies being performed that demonstrate the safety and efficacy of strength training after THA/TKA. If you can imagine, coming up with a study, funding it, getting it approved through an institutional review board, finding an ample number of subjects, etc all pose a large hurdle to overcome to get quality research evidence. Even then, when you do get a study testing progressive resistance training S/P THA/TKA, the results get watered down by the researchers putting together exceptionally poor methods because their understanding of progressive resistance training is different than what we understand it to be.

    The potential risks of actual strength training after THA/TKA would be: risk of failure of the prosthesis (either by failure of the bone to which it is fixated to, or by failure of the hardware itself), risk of acute injury due to poor proprioception (think crush injuries, musculoskeletal injuries, back injuries), risk of accelerated wear of the prosthesis / breakdown of the prosthesis.....

    In all honesty, that covers most of it. I think the vast majority of clinicians over-emphasize the last risk (accelerated wear of the prosthesis or breakdown of the prosthesis) when we work with S/P THA/TKA clients / patients. I, personally and professionally, think that the risk of accelerated wear is minimal simply because the joint forces during routine activities is just as high, if not higher, than it is during progressive resistance training. Also, if we over-emphasize the risk to the joint prosthesis, we somehow have narrowed your worth as a person to the prosthesis. The prosthesis is all that matters when we say things like that, and the biggest risk of not training is all the myriad of health conditions that occur in individuals who do not exercise or train often enough.

    If I had either a THA/TKA, even if I had bilateral THA/TKAs, I would not hesitate to go back to barbell training. It may look a bit different than prior to the joint replacements, but I am not sold on these risks enough to prevent myself from doing it.

    I had a THR 17 years ago and this the best explanation that I have heard for continuing training. As Will points out there are not enough studies to support training, but plenty within medical community have the opininn not to train, but walk and swim. I have done all of the lifts with success from age 51 -67 and still do them. With pretty decent results with one one setback within the past 3 years do to a back issue which I have since overcome.

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    Quote Originally Posted by Dandd75 View Post
    Thank you. As to the point that health care providers worry only about the life of the implant, I can certainly testify to; while interviewing surgeons for my needed bilateral THA it was more then hinted at by a few surgeons that I should really just swim or walk for exercise, which begs the question if joint replacement surgery is meant to improve the patient’s quality of life, yet the health provider is also saying that you can not return to actives that gave said person happiness (and that is leaving aside the enormous physiological benefits of training) what the bloody hell is the point of doing the surgery if there is little pain, but almost complete loss of any ROM (which is my case). I sink like a stone in the pool, and walking only gets my heart rate up a bit.
    I limped for 6 years before deciding to have THR. I wanted my life back in some way shape or form. I worked with a PT who was a former PT for a major sports organization and he eliminated my limp which I had developed over the years. I went back to upper body workouts and tired of that and then introduced deadlifts in a smith machine ,and then graduated to squatting again. I had a history of strength training so I had a background In how to train and knowing movement patterns. Over the past 14 years I worked up to a squat of over #350 and a deadlift of over 400# . I am age 67 so with smart sensible training you can accomplish your goals

    Good luck

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    Quote Originally Posted by Thip View Post
    I limped for 6 years before deciding to have THR. I wanted my life back in some way shape or form. I worked with a PT who was a former PT for a major sports organization and he eliminated my limp which I had developed over the years. I went back to upper body workouts and tired of that and then introduced deadlifts in a smith machine ,and then graduated to squatting again. I had a history of strength training so I had a background In how to train and knowing movement patterns. Over the past 14 years I worked up to a squat of over #350 and a deadlift of over 400# . I am age 67 so with smart sensible training you can accomplish your goals

    Good luck
    Well done, sir. I think most who go into barbell training in good faith will see similar results. I wouldn't hesitate to train that way myself, nor would I hesitate in the clinic if someone who just had a bilateral THA/TKA wished to rehab that way.

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    Quote Originally Posted by Will Morris View Post
    Well done, sir. I think most who go into barbell training in good faith will see similar results. I wouldn't hesitate to train that way myself, nor would I hesitate in the clinic if someone who just had a bilateral THA/TKA wished to rehab that way.
    Thanks Will. Seventeen yrs ago I was in the dark as to how to proceed. I asked the surgeons assistant about the tensile strength of the femur since it was reamed out for the titanium rod that provided the ball of the joint, and he asked why ? I said for strength training. He brought the surgeon in and he said no lifting ,and you will “hurt your back”. Not a good enough answer, as a lot goes into the science of the THR with respects to the type of implant, skill of the surgeon, density of the bone, current physical condition, and nutrition.

    I went to the PT and he helped me get over the limp that I had for 6-7 years. There was no weight training involved. I went back to the gym and did cycling classes and upper body training. Not a happy camper as it is my belief that all power/strength starts with the lower body. Cue the leg press, and then the machine that lets you work the “Butt" as well as the adductors and abductors . I was probably the only guy to use it, but it was a plan to raise leg strength, cure atrophy over a 6-7 year period. After feeling better I started deadlifts on the smith machine, ( I believed that they minimized any joint instability, and I could concentrate on strengthening the muscles and surrounding area of the joint).

    My cycling instructor was a former ARMY RANGER and took an interest in strength training, and we bonded over this shared experience even though he was 13-14 yrs younger than myself. Nothing like youth for a challenge. Eventually I started to do squats and what a sensation in realizing leg and hip strength disparities between legs. I started at 135# and over the next few years approximately 6-8, I put together my garage gym after having been moved to a work office in my home. I eventually got up to a power clean of 185# at age 58 not having done them for 14 years. I got my squat up to a 1 rep max of #400 and a deadlift of #450. Not great numbers, but these sort of held until age 64 then some back issues due to out working my ability to recovery and age. All that time I had been pushing a prowler and sled dragging.

    I have a background in Health so what I knew helped along with a large dose of "Do not tell me what I can and cannot do within reason” . Also skepticism of the Healthcare field also fed into my decisions. People like yourself and Dr John Petrizzo are improving quality of life through strength training and rehab, even though it is viewed with skepticism by the so called "in the know” surgeons.

    Sorry to be so long winded, but I know what it was like 17 years ago without any information about strength training and THR , and no PTs that I was aware of using strength training for rehab. You and John are at the forefront of this education, and advising people how to get their lives back as well as getting back into strength training.

    Keep on keeping on ! THIP

  10. #10
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    Quote Originally Posted by Thip View Post
    Thanks Will. Seventeen yrs ago I was in the dark as to how to proceed. I asked the surgeons assistant about the tensile strength of the femur since it was reamed out for the titanium rod that provided the ball of the joint, and he asked why ? I said for strength training. He brought the surgeon in and he said no lifting ,and you will “hurt your back”. Not a good enough answer, as a lot goes into the science of the THR with respects to the type of implant, skill of the surgeon, density of the bone, current physical condition, and nutrition.

    I went to the PT and he helped me get over the limp that I had for 6-7 years. There was no weight training involved. I went back to the gym and did cycling classes and upper body training. Not a happy camper as it is my belief that all power/strength starts with the lower body. Cue the leg press, and then the machine that lets you work the “Butt" as well as the adductors and abductors . I was probably the only guy to use it, but it was a plan to raise leg strength, cure atrophy over a 6-7 year period. After feeling better I started deadlifts on the smith machine, ( I believed that they minimized any joint instability, and I could concentrate on strengthening the muscles and surrounding area of the joint).

    My cycling instructor was a former ARMY RANGER and took an interest in strength training, and we bonded over this shared experience even though he was 13-14 yrs younger than myself. Nothing like youth for a challenge. Eventually I started to do squats and what a sensation in realizing leg and hip strength disparities between legs. I started at 135# and over the next few years approximately 6-8, I put together my garage gym after having been moved to a work office in my home. I eventually got up to a power clean of 185# at age 58 not having done them for 14 years. I got my squat up to a 1 rep max of #400 and a deadlift of #450. Not great numbers, but these sort of held until age 64 then some back issues due to out working my ability to recovery and age. All that time I had been pushing a prowler and sled dragging.

    I have a background in Health so what I knew helped along with a large dose of "Do not tell me what I can and cannot do within reason” . Also skepticism of the Healthcare field also fed into my decisions. People like yourself and Dr John Petrizzo are improving quality of life through strength training and rehab, even though it is viewed with skepticism by the so called "in the know” surgeons.

    Sorry to be so long winded, but I know what it was like 17 years ago without any information about strength training and THR , and no PTs that I was aware of using strength training for rehab. You and John are at the forefront of this education, and advising people how to get their lives back as well as getting back into strength training.

    Keep on keeping on ! THIP
    What I wouldn't give to have 10% of my patients have a half ounce of what you have, sir.

    I've, so far, been able to convince every single orthopaedic surgeon I have worked closely with that this is a better way to rehab post-operative cases. Once they see the results for themselves, they have all become believers. I have standing job offers with each and every one of them to work with them after they leave the military. So much of that is parroted dogma. To the uninitiated, it seems reasonable, but once they have been able to see the patients' responses to progressive loading through resistance training, they are completely on board with it.

    I'm currently working with a wonderful lady that recently had a bilateral TKA. Prior to the operation, she was 20kg over the maximum allowable body weight for them to be able to complete both replacements in the same surgery. She worked tirelessly prior to surgery, dropping 30kgs in the process. She had the surgery in October (had both replaced in the same surgery), and is currently squatting to near full ROM, trains 5 days per week (including boxing), and is more active now than she was since leaving professional ballet. On occasion, her knees stiffen up, but overall, her quality of life is far greater. She can walk, care for her grandchildren, and travel the country relatively pain free. The in-person physio she worked with immediately after the surgery did his best to manage her expectations of what was possible, but she has exceeded all prognostications given by the physio and the surgeon.

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