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Hips and knee surgery evolves

Nurturing

BACK ON COURT Andy Murray, who recently underwent hip resurfacing, during his third-round straight-sets win over João Sousa at the 2015 Australian Open.

And attitudes towards arthritis change

Health
Andrew O'Brien

Andy Murray was playing tennis at the Queen’s Club tournament in London last week. ‘No big deal,’ says you, ‘and besides, he was only playing doubles’.
We all know Murray made his name as the hardest working singles player around. A guy who, despite having the misfortune of coming on the scene as Federer, Nadal and Djokovic were all in their prime, managed to win three Grand Slam titles, two Olympic gold medals and somewhere in the region of €54 million in prize money.
So, what’s the big deal about him playing doubles at an event that is basically a warm-up for Wimbledon?

Very hip
Having struggled for some time with a hip injury, Murray underwent a procedure in January of this year known as hip resurfacing, an alternative to a total hip replacement. The procedure consists of placing a cap over the head of the femur and a matching metal cup in the acetabulum – the pelvic socket – replacing the articulating ‘ball and socket’ surfaces of the patient’s hip joint and removing very little bone compared to a total hip replacement.
The fact that the patient retains more bone at the top of their femur allows them to recover faster, and to a higher level of activity than patients who have undergone total hip replacements. There are other elite athletes who have returned to sport after the surgery, and that number is likely to grow as surgical and rehabilitation practices evolve.
Murray’s case makes a small mockery then, of the once common warning that ‘you have the joints of an 80 year old, and you’ll need a replacement before you’re 50.’

Knees up
And while knee replacement surgery hasn’t progressed quite as much as that of the hip, a total knee replacement isn’t quite the demon it was once made out to be.
Advancements in surgical techniques, the prosthetics used and pain management mean that where knee replacement patients were previously warned to expect to be in pain for at least six months post-op, that time frame is now more like six weeks.
In the past, a knee replacement was considered to have a life-span of ten years or so, so many patients were advised to delay surgery as long as possible so as to reduce the likelihood of complicated revision surgery down the line. Now, it is expected that 80 percent of knee replacements will last 25 years, so surgeons are operating on younger patients, who typically recover faster and more fully than older patients.

No longer crippling
Perhaps just as important as the surgical improvements has been the change in attitude towards arthritis. In the past, arthritis was seen as something that ‘set in’ and left you ‘crippled’. MRI studies in recent years have shown that symptom-free subjects are likely to have just as many ‘degenerative’ changes as subjects with pain, added to which it has been shown that marathon runners are less likely to require joint replacements than non-runners. And so, the warnings not to do something for fear of damaging your joints can now be consigned to history.
I often tell the story of a man I saw hiking the Inca Trail in Peru. I was sitting at the top of a mountain pass waiting for the rest of my group and got chatting to another hiker. We could see a tall, well-built man with two knee supports and walking sticks in each hand dragging himself up the mountain towards us.
I made a comment about how long the day was going to be for the poor bloke when my companion laughed and told that the man was his uncle. The uncle had been told by his surgeon that he needed two knee replacements. But he’d had a lifetime dream to see Machu Picchu, and when he realised how long it would take to recover from two rounds of surgery, he’d decided to delay the op and go to Peru instead. His reasoning? ‘The knees are gone anyway; I might as well give them a good send off!’.
And somewhere in all of this, there is a message. Being and staying active may contribute to some joint issues, but it also may protect you from them, and the joint replacement surgeries that we were always afraid of aren’t as bad now as the used to be. And if you have it done, who knows, this time next year you might be preparing for Wimbledon.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.