Resurfacing and Replacing: Bringing Joints Back to Life

Editor's Note: This article was originally written by Daniel O'neill, M.D.

Doctors have been trying to resurface our worn out joints with various materials for many years. It was not until English surgeon, John Charnley, perfected his hip replacement in the 1960's, that this technology really took off. Flash forward 15 years and a very impressionable medical student was drawn to Orthopedic Surgery seeing people with these new joints walking without pain. When I did my first knee replacement (really it should be called knee "resurfacing" since we just shave off a few millimeters of damaged bone and cartilage and then put on a new metal surface - similar to capping a tooth) we were still lining things up by eye. Now modern jigs and alignment devices make this surgery much more consistent.

Both hip and knee replacement surgery have come a long way in the past 30 years; however we are still replacing living, growing, self-repairing tissue with combinations of metal and plastic. The trick - trust me, we have still not solved - is getting these inert materials to stay attached to the bone. When you hear about someone having a "revision" hip or knee replacement, most often it is because the metal pieces have loosened. While the initial joint replacement is a big deal, a revision operation is much bigger and unfortunately, is also more fragile. We saw this with Bo Jackson. He ruined his first hip replacement playing Major League Baseball, and sadly, since his revision, Bo Jackson couldn't even beat me in a race to the kitchen.

Which brings us to the point: Joint replacements are tremendous operations, but as you may have gathered from some of my other columns, I am about promoting health and fun in our lives, not about seeing how much we can punish ourselves. At our peril, some of us try to push our lives and bodies beyond reason and limits. Two recent events in the Himalayas demonstrate this well. In one, a 71-year-old man climbed the sixth highest mountain in the world, only to die that night at base camp. In the other, a 13-year-old became the youngest to summit Mt. Everest. Obviously the 71-year-old might rethink his decision to climb the mountain if he knew that would be the last thing he did. In the case of the 13-year0old, I'm not sure we have any data on the effects of high altitude on a developing brain or lungs. We would not let this boy pitch nine innings of baseball because of the risk to his elbow and shoulder, yet society seems to think this wacky goal is laudable, and clap him on the back for it.

Orthopedic academies have published lists of what we believe you should and should not do after joint replacement surgery. Notice I said should and should not, not can and cannot. You can do lots of things, but like Bo Jackson, you might be limiting the life span of your joint replacement. What sports or activities should you be doing? Just about anything that does not put undue stress on your legs. For example, golf, ballroom dancing, and doubles tennis make the recommended list. "Easy" road cycling, hiking and horseback riding for those experienced should also be fine. "Not recommended" are sports such as basketball, singles tennis, jogging and other pounding and twisting sports.

Now, I know you all have friends who are "doing fine" skiing, running and winning tennis tournaments with their new joints (though I don't actually believe you). Well, think of these folks as the exception and Bo Jackson as the norm. Your doctors, your friends, your kids and your grandkids want you around, active, pain-free and happy for years to come. Make healthy choices for your activities even if that may mean making some concessions. Don't think you're going to be the exception and be able to climb Mt. Everest when you're 70. To paraphrase Abe Lincoln, the world prefers average people - that's why there are so many of us

Dr. Daniel O'Neill, M.D., Ed.D, F.A.A.O.S. is an Orthopaedic Surgeon, Sports Psychologist, and founding member of The Alpine Clinic based in Franconia New Hampshire.