High Impact Sports Decrease life of THRs

[Pat Walter]

I found this interesting even though it was not about hip resurfacing devices.  I would assume there might be some similiarities - but who knows.


http://www.eurekalert.org/pub_releases/2012-04/s-ahf042612.php
26-Apr-2012

Artificial hips find some sports wearing

High impact sports increase quality of life but reduce durability of hip implants

Involvement in high‑impact activities such as football, skiing, tennis or martial arts, significantly increases the wear rate and reduces the 'lifespan' of hip implants in adults who have undergone total hip replacement surgery more than a decade earlier. The work by Matthieu Ollivier, from the Sainte‑Marguerite Hospital in Marseille, France, and his team is published online in the Springer journal Clinical Orthopaedics and Related Research.

A growing number of patients want to return to sport, and in some cases high-impact sports like jogging and soccer, after total hip replacement (or arthroplasty) operations. Although many surgeons already recommend certain activities more than others, little research has been performed to confirm whether these recommendations will reduce the lifespan of the artificial joint.

Ollivier and colleagues compared the function, wear rates and lifespan (or so-called 'survivorship', measured by either the need for revision due to mechanical failure, or signs of loosening) of hip implants in 70 patients who took part in high-impact sports and 140 with lower activity levels. These measurements were taken at least 11 years after the participants had the surgery. The patients were also asked to complete sports and quality-of-life questionnaires. X-rays of the hips and pelvis were taken and assessed after the operation.

Even though patients practicing high-impact sports had better function and better quality of life score than patients involved in lower-level activities at a minimum of ten years after the surgery, involvement in high-impact sport reduced the durability of the implants over a 10-15 year period. At 15 years' followup, the survivorship of the implants was 80 percent in the high-impact group compared to almost 94 percent in the low-activity group. Interestingly, both practicing a high-impact sport and being a male were factors for an increased wear rate over time, although the reasons for the gender difference are unclear.

The authors conclude: "These observations confirm experts' concerns about the potential risk related to high-impact sport and both patients and surgeons should be aware of these risks. Since participation in sport is now a reality for a significant number of total hip arthroplasty patients, surgeons may need to adapt their choices of bearing surfaces in implants to accommodate this growing trend."

[hernanu]

That's good information, Pat. The more we know, the better off we are, I think. 

It would be interesting to see a similar study for HRs, given the selection of HRs as a way to be more active.

Thanks for the link.... 

[Anna]

Thanks for sharing that Pat.

I think its good to take information like this and use it to find a sensible balance between what we want to do and what we should do. We all want to get the most out of our hips and we all want to take them to the grave .... but at the same time, we all chose life and want to do the things we enjoy. Studies and info like this can only help us make the right decisions without taking too many risks. As hern says, the more we know, the better off we are!  :)

Anna

[bluedevilsadvocate]

Interesting ... and a little disconcerting since I play tennis.  It would be nice to have further details on the specific devices that the surveyed patients had.  I am inclined to think that most devices used in the last 15 years have had polyethylene liners in the acetabular cups, which have a dramatically higher wear rate than the MoM used in HRs.  In fact, the last phrase of the report --- "surgeons may need to adapt their choices of bearing surfaces in implants to accommodate this growing trend" --- perhaps suggests that the more durable MoM bearing surfaces of HRs will better "accommodate this growing trend."

[maxx6789]

thanks, pat. this is why i will likely never run road races again (something i did more for exercise than passion) but plan to continue with sports that i do love like wakeboarding and snowboarding. it's all a bit of a balancing act ... with no guarantees no matter what you do.

[John C]

Hi Hernanu,
Just a thought about your question about an activity study specifically on resurfacing. A while back I posted a link to a report by Dr Amstutz that posted similar results for resurfacing, though as you pointed out it was a pretty small study, just 445 patients. Just to refresh our memories, his numbers were pretty similar; 96.4 survival out ten years for lower activity scores, and 88.8 for higher activity scores. He specifically mentioned tennis, one of my main summer sports, as a high risk sport. So far, the joy that I get from it outweighs the additional risk for me.

[Dannywayoflife]

I thought that McMinn had done a study that showed high impact has no longterm effect if the device was full healed before they were started?

[hernanu]

Hi Hernanu,
Just a thought about your question about an activity study specifically on resurfacing. A while back I posted a link to a report by Dr Amstutz that posted similar results for resurfacing, though as you pointed out it was a pretty small study, just 445 patients. Just to refresh our memories, his numbers were pretty similar; 96.4 survival out ten years for lower activity scores, and 88.8 for higher activity scores. He specifically mentioned tennis, one of my main summer sports, as a high risk sport. So far, the joy that I get from it outweighs the additional risk for me.

That's right, John - thanks for reminding me. I guess for me the higher activity is worth the risk, at least (for me) the odds are still pretty good.

Danny brings up a good point, which is why further knowledge would be great to have. It would be nice to know the results when you exclude activity earlier than desired by the surgeons. The more we know (and remember ) the better off we all are.

[Tim Bratten]

I looked at the original article: the THRs considered were polythene on metal and the major cause of revision in the active patients was "asceptic loosening" which happens when plastic debris causes tissue and bone damage that results in the implant coming loose.   

[Dannywayoflife]

If tim is correct then aseptic loosening isn't really an issue from what I've read about resurfacing unless the device is incorrectly placed then causing edge wear. The difference in wear between a vitalium BHR/HR device and a metal on poly THR is like night and day. One wears the other doesn't really

[morph]

Yeah, the large plastic particles cause osteolysis. The bodies immune system gets confused and attacks the bone, the stem then becomes loose. Hence why metal on plastic is a bad idea for young active people. I don't think this is the case with smaller metal ions from HR which has much lower wear.

[Dannywayoflife]

Mark Bloomfield explains a lot about the development of modern devices and how cement got blamed for failures because at the time they didn't have the ability to understand the plastic particles causing ostolysis.