Member Case Study: Triathlon Training with Hip Replacement

author : AMSSM

comments : 1

I decided that, after having a new hip put in 11 months ago, I needed a new lifestyle. Just wondering if there's anything that I should know about-especially for the running and biking.

Member Question from WINDIE

"I've never done anything like this before.  I decided that, after having a new hip put in 11 months ago, with my new hip I needed a new lifestyle.  So I've decided to do my first tri (sprint distance) on May 31st.  I'm 53 and I'll be "tri-ing" in the Athena group.  I know I'll be okay with the swim and the ride and figure that I can at least walk the five kilometers if I have to.  Just wondering if there's anything that I should know about - especially for the running and biking."

Answer from Kenneth Cayce, IV, M.D
Member AMSSM

There are over 594,000 knee and hip replacements performed each year in the United States.  The complications, although uncommon, are dislocation, periprosthetic fracture, and implant breakage.  Athletic activity increases the stress on the implant and studies have shown that high use and activity levels contribute to loosening rates of the total joint replacement.  Thus, active and high demand activities place the joint replacement at risk for loosening and wear.  There was a study in Sweden that showed that more active younger athletes had a 3 – 4 times higher revision rate of their replacement than average.  There are no good studies on athletic activity after a total hip or knee replacement and its effect on survival.  Current recommendations are based on opinions by physicians.

I have provided a table for the activity recommendations after a total hip replacement.

Healy, Iorio, and Lemos: Athletic activity after joint replacement. Am J Sports Med 29(3):377-388, 2001.

Wear of the joint is a function of use, not time, and has a strong correlation to load.  So, it would be a good recommendation to do activities that have lower joint loads like swimming, cycling, and walking.  When doing activities with high joint loads, every effort should be made to reduce the joint loads as much as possible.  This can be done by wearing inserts in the shoes and using ski poles while skiing.  Joint loads can be higher for those individuals who are beginners as compared to individuals who have been exercising prior to surgery.  These beginners are at a higher risk of sporting accidents and having damage to the joint replacement.  As a general rule, loads of up to three to four times body weight occur during sporting activities.  Cycling is the easiest on the joint replacement with ranges from 1.2 to 1.5 times body weight loading the hip and knee (which is less than walking).  For running, it can have loads of 10 times body weight or more.  Here is a table of some joint loads during different activities:

m=miles
Kuster. Exercise recommendations after a total joint replacement: A review of the current literature and proposal of scientifically based guidelines. Sports Med 32(7):433-445, 2002.

To answer your question, you are correct that the swimming and biking parts are well documented to have less risk with low joint load.  I would train on a treadmill and would walk during the running part of the triathlon.  I would also get some shoe inserts for your running shoes.  Good Luck.

Kenneth Cayce, IV, M.D. is a Primary Care/Sports Medicine Physician at MAX Sports Medicine. Dr. Cayce is currently accepting new patients by calling (614) 828-4241 for an appointment.

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date: April 14, 2010