Cartilage, Part 6

In this final installment of the cartilgage series, we'll address "healing with steel."

Are you getting the idea that dealing with cartilage wear is a difficult problem for Masters athletes who want to stay active? It is a difficult problem. This is because cartilage has a poor healing capacity at any age and this simply gets worse the more years we accumulate.

Despite amazing conservative, surgical and biologic advances in the care of worn cartilage, there sometimes is a point where even the athlete must consider "healing with steel."

Just because you have arthritis does this mean you have to quit being active? ABSOLUTELY NOT It may mean that you have to change how you train.You might have to cycle instead of run, or start cross training to give your joints a rest. Even getting a joint replaced doesn't mean you have to stop. There are many participants in the Senior Olympics who have artificial joints, and these athletes run, pedal and swim their way into the winner's circle. Being bionic is not all bad.

Many of you probably think that knee replacement means that you are doomed to sit on a rocking chair for the rest of your life. The truth is that I and many of my colleagues view joint replacement as a LISCENSE for MOBILITY. This is because instead of hobbling around in with pain and with stiffness for years, you are finally able to get back to doing the activites you love to do and do them with none or little difficulty.

Seriously, many of my patients return to sports: tennis, cycling, rowing, team sports, swimming. Everything except distance running. I'm sure some of my patients even try to run; they just don't tell me.

So what is joint replacement? When cartilage wears down and the bones begin to rub on one another, it causes both pain and deformity. One side of the knee wears out faster than the other and the bones become lopsided. For most, we wear out the inside (medial) portion of our knee joint and the top of our hip joint first. This is why you see many people becoming bow-legged as they age.
 
All joint replacements, therefore, are meant to decrease pain and realign joints straight again. Joint replacement is performed by making an incision over the involved joint and removing the ends of the bones that no longer have cartilage on them. Special jigs are used to measure and align the cuts made on the ends of the bones to make sure the new joint is anatomically aligned like the natural joint was before arthritis wore it down. Now we are even using computer navigation in the operating room to more precisely align the bone cuts back to their natural anatomic position.  

Once all the bone cuts have been made, the ends of the bones are replaced with metal replicas. Prior to surgery, X-rays are measured to ensure the proper sized implants are available, and during surgery the surgeon measures to determine what size joint replacement is needed. When the surgeon confirms the proper size and alignment of the implants, they are cemented into place. This is why you can walk on joint replacements immediately.

The implants are made out of cobalt-chrome, ceramic or titanium alloys and are polished to a highly shiny surface. They reflect light like a polished chrome bumper or a mirror. Between the two polished steel implants, a very tough piece of plastic, called polyethylene or poly, is inserted. The two bone ends move over this poly surface like your natural joint moved over its cartilage.

Rehabilitation after a this operation can take three to six months depending on the kind of shape a patient is in prior to surgery. The post-operative results, however, are generally excellent with significant relief of pain and return of function. More than 90 percent of people continue to have good or excellent results more than 10 years after joint replacement.

You can find more information about joint replacement at the American Academy of Orthopaedic Surgeon's Web site:

http://orthoinfo.aaos.org/menus/arthroplasty.cfm

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Exercise is life

I'm about to tell you something that, as a Masters athlete, you already know: Exercise keeps you younger from the inside out! It keeps your muscles powerful, your bones strong, your heart and lungs youthful and efficient and your brain sharp!

Did you know that long term exercise is the key to longevity? Now you have even more ammunition to fire back when people think you are crazy for continuing to push yourself.

Hot off the presses is a study in the Archives of Internal Medicine from  Stanford University that found that "older runners are less likely to become disabled with age and may live longer."

Eliza Chakravarty, M.D., surveyed 284 members of a nationwide running clubs, and 156 healthy but sedentary controls about their activity level, disability level and body mass index over 19 years. She found the following results:

1. At the beginning of the study, runners were leaner and less likely to smoke than the non-runners.
2. After 19 years, two times as many sedentary participants had died compared to runners (34 percent vs. 15 percent).
3. Disability levels were lower among runners compared to non-runners no matter how old they got.
4. After 21 years the high disability rates in the sedentary controls translated into important limitations in daily life functions.
5. The differences between the disability and survival curves between the two groups continued to get larger even as the participants approached their 90th birthdays.

The study concludes, "&decreased disability in addition to prolonged survival amongh middle-aged and older adults participating in routine physical activities further support recommendations to encourage moderate to vigorous physical activity at all ages.  Increasing healthy lifestyle behaviors may not only improve length and quality of life but also hopefully lead to reduced health care expenditures associated with disability and chronic diseases."

This study makes that same point that my recently published study in the American Journal of Sports Medicine made. Consistent exercise is the key to aging well and is important to individual health but also the health of our country as we try to find ways to keep our Baby Boomers healthy longer.

Now, get back to your workout.

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