EXERCISE POST TKR

Very often, we have been told that we should not do any exercises that involves high impact activities such as jogging, running, aerobics, football, basketball etc. after TKR.  This is to avoid early failure of the knee replacements which may lead to a revision.

When I started to do my high intensive exercises which involves jumping jack as cardio, I was worried about my implants.  But I wanted to do it because its really effective for cardio plus it helped me to lose some pounds before.  So I tried and initially, it felt a little unnatural but after a while, I got the hang of it.  However, the whole time I was doing it, I was worried about my implants.  When I shared about this experience in my blog, some of my readers raised their concerns about me doing the jumping jack because they were advised by their OS not to do such activities in order to prevent loosening of the implants.  This confirmed my fears and so I stopped doing it. 

On the other hand, some of my forum members have said that they could not care less about the implication.  The reason they gave is that after being unable to do the things they loved for so long, TKR has enabled them to resume their love for sports and if they ended up needing a revision, so be it.  Now that's a whole different attitude which is really brave and I must admit that I tend to be more cowardly in this area.

So is high impact activities safe for implants or not?  There is an article in Arthritis Today titled Knee Replacements Not Harmed by Most Sports.  It said that a new study suggests that high-impact activities don't contribute to the early failure of knee implants.  This study suggests that those long-held assumptions could be wrong.  The study compared two groups of people with knee implants over a period of 7.5 years.  The sport group that ignored doctors' advice to avoid high-impact activities did not show any significant differences in wear or tear mechanical failure compared to the control group who followed doctors' advice.  Its even more surprising that the control group had a higher rate of loosening, wear, fracture and overall mechanical implant failure than the sport group. 

So why aren't high impact sports affecting the implant after 7.5 years?  The researches felt that it could be due in part to better-made prosthesis that are thicker and stronger than ones produced years ago.  They also think that patients practising these kinds of sports were probably doing it before the prosthetics so they have experience and are probably more able to protect the prosthesis by being more careful and paying attention to their knees.  However, there are concerns that the length of the study is only medium term and what is required is to show a longer term of 15 to 20 years. But the researchers said that intermediate follow-up lends credence to the idea that more activity is ok for implants.  They also said that its worthwhile reporting even though it doesn't conclusively prove they are safe.  So patients have to decide whether its worth the minimal risk in order for them to lead an active lifestyle.

Another inspiration is Dick Beardsley who is a recovering addict, motivational speaker and marathon runner.  He had battled back surgery and 2 TKRs due to injury and is still running.  You can check out his blog to read about his experience with TKR and running. 

So where does all this information lead us to? I think the answer really depends on the individual.  Fortunately for me, I am not into high impact activities.  I enjoy walking, cycling, stretching and strength training.  I have also recently added dancing as an exercise through a home video.  I can conclusively say that if I accidentally ran after a thief who snatched my bag or if I suddenly decided to jog lightly down the hill during my walks, I would not worry about my implants anymore!



ARTHRITIS

The word "arthritis" comes from the Greek arthron meaning "joint" and the Latin itis means "inflammation".  So arthritis literally means joint inflammation.  There are so many types of arthritis but the most common is Osteoarthritis and Rheumatoid Arthritis.
 

Recently, I was tidying up my home library and I found two old books on Arthritis which I had completely forgotten about.  One was written by Stephen Terrass and the other by Patrick Holford.  I read the books again and found a lot of interesting information.  According to Stephen Terrass, it is believed that arthritis has been around for some time.  Scientific literature tells us that the fossil of a large, swimming reptile called the platycarpus, which lived almost 100 million years ago, showed evidence of arthritis.  Signs have also been detected in the bones of cavemen, and in the spines of several 8,000 year old Egyptian mummies.  And in Roman times, it was considered such a burden that the emperor Diocletian exempted citizens with severe arthritis from taxes.  Wouldn't it be nice if this is applicable today? Because I think most of us would be eligible for tax exemption!

It was also said that OA being the most prevalent form of arthritis affects three out of four people over the age of 50.  A fatalist would say that arthritis is almost a certainty - like death and taxes.  However, the author points out that this is far from the truth because it can be prevented. I agree with that because so much of research have been carried out today and most of us have become more educated and conscious of our health.  Apart from genetics, research has pointed out that our diet and lifestyle can cause arthritis.  Therefore, we hold much of the ability to eliminate such problems.  Of course, medicines and treatments are important but the one sure thing to cure arthritis is to prevent it in the first place.

Rheumatoid Arthritis

One of the most common arthritis is Rheumatoid Arthritis (RA).  RA is a form of inflammatory arthritis and an autoimmune disease that causes the body to attack its own soft tissues and joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that is systemic - meaning that it can occur throughout the body. RA most commonly affects the joints of the hands and feet but it can also cause elbow, shoulder and neck problems. Joint swelling is often more pronounced in RA.
 

The cause of RA is still unknown but most scientists agree that a combination of genetic and environmental factors is responsible. Researchers have identified genetic markers that cause a tenfold greater probability of developing RA. There are nearly three times as many women as men with the disease. In women, RA most commonly begins between the age of 30 and 60. It often occurs later in life for men.
 

Juvenile Rheumatoid Arthritis (JRA) is another auto-immune condition but it tends to affect children and adolescents. There is a broad spectrum of JRA with some patients having just one joint involved and others having many problems. The most commonly involved joint is the knee. The only cure for JRA is joint replacement. I have come across two people who have JRA with severe joint damage at the knees. One of them got both of her knees replaced at age 28 while the other did a bilateral TKR at age 31. While TKR helped them to gain their life back, their biggest challenge was finding an OS who was willing to do TKR for them at that young age.

Osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis.  In my earlier post on OA, I mentioned that it is commonly thought that OA is caused by a wear and tear condition due to ageing.  However, studies have now shown that OA may be caused by other factors such as inflammation.
 

I came across Dr Robert H. Shmerling's blog where he said that he heard about a joke when he first started studying arthritis  -  A 90 year old man sees his doctor complaining of pain in his knee.  His doctor asks him, "What do you expect? You are 90 years old".  The old man replies, "Yes, but my other knee is also 90 and it feels fine".  Isn't this hilarious?  And I think it proves a point.
 

It was also said that studies conducted on runners in 1998 over a nine-year period showed that members of a running club ages 50 and older had no higher incidence of OA than an otherwise similar group of non-runners. 
 

What about people who suffers from arthritis of the hands?  It was said that when OA affects the hands, this is the best argument against a direct connection between use (or overuse) and OA. Finger joints with OA look very similar to the knees with OA, yet not everyone bears weight on the hands. If 90% of people are right handed and if OA was purely use-related, there ought to be a lot more right hand arthritis compared to left hand arthritis but this is simply not the case. 

So what causes OA if its not the wearing out of joints?  Apparently, OA may not be caused by one single factor.  It can be caused by a combination of factors such as advanced age, obesity, genetics or injury. However, I find it hard to understand why OA is affecting more and more younger people.  Some of them are not even obese, did not experience any injury, are physically active and healthy.

According to Dr. G's blog, he said that he started to experience arthritis symptoms at 46 years of age.  He did not have any of the traditional risk factors like obesity, joint over-use or sport injuries so he started to think why he is getting OA so early in life.  He found through his own research that OA is not a disease of ageing or degenerative disease.  He said that more and more research over the past 10 years is showing that OA starts out very similar to other chronic diseases like heart disease, stroke, diabetes etc.  Ageing is not the cause.  It is chronic inflammation.  It is the bad type of inflammation which is also responsible for a lot of other diseases.

I have much earlier shared a link to a study by Stanford University School of Harvard in my post on OA still exists after TKR?  The study suggests that OA results from inflammatory process, not just wear and tear.  It was observed in the study that there were increased numbers of certain specialized inflammatory proteins early in the progress of OA, before it becomes symptomatic which suggested that inflammation might be a driver, rather than a secondary consequence of the disease.  Right now, they don't have anything to offer OA patients to treat their underlying disease but it would be incredible to find a way to slow it down.

All the above information suggests that there is a paradigm change in the underlying disease of OA.  Perhaps this explains why it is affecting more and more younger people. The more I researched, the more it is pointing to this direction.  In my earlier post on "pH Balance and Arthritis", it was said that an acidic body may lead to inflammatory diseases.  I wonder whether all these findings are connected.  Anyhow, I am certainly hoping that the experts find a solution soon in order to prevent or slow down OA.  Until then, lets be more proactive by taking a good look at our diet and lifestyle and start making necessary changes.  Even if it can't reverse our arthritis condition, maybe it can help to prevent more damage.



Arthritis