Revista de Medicina Desportiva (English) July 2018 - Page 18

allowing physical and mental advantages in all age groups . 34-36 It is clearly demonstrated the benefit of replacing a joint in an advanced degeneration stage , in particular of the hip , knee and shoulder , allowing of pain relief , improved function , correction of deformities and
34 , 36-38
improvement of the life quality . In the face of the success of arthroplastic surgery , the expectations of the patients increased , and currently many not only want the symptomatic pain relief , but also functional recovery , trying to overcome the limitations caused by arthrosis and even practise some degree of physical and sport activity . 34 , 36 , 38 Some patients have the goal of returning to a particular sport that had been restricted from practising due to degenerative
36 , 39
osteoarticular pathology .
The scientific literature on sport after arthroplasties is limited to small retrospetive studies with little follow-up time , mostly insufficient for the evaluation of the joint prosthesis survival . 34 , 36 Current hip and knee total prostheses have an average survival of more than 90 % at 10-20 years after their application and , as such , it is accepted that the minimum follow-up time to evaluate arthroplasty survival is 10 years , precisely the time when complications begin to appear . 36 , 40-43 The practice of physical exercise , by causing increased forces exerted through the joint prosthesis , can become an important risk factor for early failure . It has been demonstrated for hip , knee and shoulder prostheses
that a high level of physical activity can increase the risk of stress and wear between the implant components and the prosthetic-bone interface and , consequently , early loosening and instability of the joint prosthesis . 34 , 36 Similarly , an athlete with a disc prosthesis may in his activity cause potentially excessive charges on the implant , which may lead to failure and early dysfunction . 3 Thus , in theory , high impact , contact and competition sports , by providing repeated and intense axial and / or rotational loads on the spine and intervertebral implant , may be associated with a higher risk of periprothesis osteolysis , migration and wear of the implant , with consequent early failure of the disc
5 , 44 , 45 prosthesis .
Despite the arthroplasties have already demonstrated consistent results in the hip , knee and shoulder , disc arthroplasties are still very recent and the studies on their results in the medium and long term are limited . However , the promising results of these prostheses in terms of safety , symptomatic relief and functionality in the general population , considering at least equivalent to classical treatment with arthrodesis , have led to their popularity growing , being increasingly applied in younger , more active patients and with higher functional expectations . 3 , 5 , 46 , 47 Despite this trend , few studies have evaluated the limitations and potential risks of these arthroplasties . In sports practitioners , the level of activity that should be allowed for patients with these implants and the ideal time to resume sporting practice as not to compromise the prosthesis
survival remain unclear . 3 , 5 This issue is of particular importance in the competition sports practitioners , in which a quick return to the sport is intended , preferably at the same functional level prior to the development of the condition . The fact that most of the time the disc prostheses are applied in young people , who will probably continue to practice sporting and consequent loads on the disc prosthesis for several years , may jeopardize the integrity of the arthroplasty , however these data remain to prove . 5
Siepe Cj et al . prospectively studied 39 practitioners from several sports ( average age 39.8 and interval 26.2-58 years ) that underwent lumbar disc arthroplasty ( Figure 3 ), with an average follow-up time of 26.3 months ( interval 9-50.7 months ). 3 They found out significant symptomatic improvement in all patients ( average decrease of 5.7 on the visual pain scale and 30 % decrease on Oswestry Disability Index ). The arthroplasties were unilevel in 92.3 % of the sample and the remaining were bilevel , with the most affected levels being L4-L5 and L5-S1 . The inclusion criteria should include more than one of the following requirements : sports practice frequency equal to or greater than twice a week before and after surgery , participation on contact or high impact sports , professional athletes or similar . The final sample included practitioners of various sports , with various levels of activity , from recreational to professionals . The return to spots occurred in 95 % of the athletes and it occurred during the first three months in 38.5 % and between 3 and 6 months in 30.7 % of the sample , with the maximum
Figure 1 – Mobility difference between disc arthroplasty ( green line ) and arthrodesis ( yellow line ) of two levels in the cervical spine 1
Figure 2 – M6 ® lumbar disc prosthesis – L . Artificial reproduction of the fibrous anulus ( Artificial Annulus ) ( made of polyethylene ) and pulposus nucleus ( Artificial Nucleus ) ( made of polycarbonate-urethane ) 33
16 july 2018 www . revdesportiva . pt
allowing physical and mental advantages in all age groups. 34-36 It is clearly demonstrated the benefit of replacing a joint in an advanced degeneration stage, in particular of the hip, knee and shoulder, allow- ing of pain relief, improved func- tion, correction of deformities and improvement of the life quality. 34,36-38 In the face of the success of arthro- plastic surgery, the expectations of the patients increased, and currently many not only want the sympto- matic pain relief, but also functional recovery, trying to overcome the limi- tations caused by arthrosis and even practise some degree of physical and sport activity. 34,36,38 Some patients have the goal of returning to a par- ticular sport that had been restricted from practising due to degenerative osteoarticular pathology. 36,39 The scientific literature on sport after arthroplasties is limited to small retrospetive studies with little follow-up time, mostly insuf- ficient for the evaluation of the joint prosthesis survival. 34,36 Current hip and knee total prostheses have an average survival of more than 90% at 10-20 years after their application and, as such, it is accepted that the minimum follow-up time to evalu- ate arthroplasty survival is 10 years, precisely the time when complica- tions begin to appear. 36,40-43 The prac- tice of physical exercise, by causing increased forces exerted through the joint prosthesis, can become an important risk factor for early failure. It has been demonstrated for hip, knee and shoulder prostheses that a high level of physical activity can increase the risk of stress and wear between the implant com- ponents and the prosthetic-bone interface and, consequently, early loosening and instability of the joint prosthesis. 34,36 Similarly, an athlete with a disc prosthesis may in his activity cause potentially excessive charges on the implant, which may lead to failure and early dysfunc- tion. 3 Thus, in theory, high impact, contact and competition sports, by providing repeated and intense axial and/or rotational loads on the spine and intervertebral implant, may be associated with a higher risk of periprothesis osteolysis, migra- tion and wear of the implant, with consequent early failure of the disc prosthesis. 5,44,45 Despite the arthroplasties have already demonstrated consistent results in the hip, knee and shoul- der, disc arthroplasties are still very recent and the studies on their results in the medium and long term are limited. However, the promis- ing results of these prostheses in terms of safety, symptomatic relief and functionality in the general population, considering at least equivalent to classical treatment with arthrodesis, have led to their popularity growing, being increas- ingly applied in younger, more active patients and with higher functional expectations. 3,5,46,47 Despite this trend, few studies have evaluated the limitations and potential risks of these arthroplasties. In sports practitioners, the level of activity that should be allowed for patients with these implants and the ideal time to resume sporting practice as not to compromise the prosthesis Figure 1 – Mobility difference between disc arthroplasty (green line) and arthro- desis (yellow line) of two levels in the cervical spine 1 Figure 2 – M6 ® lumbar disc prosthesis – L. Artificial reproduction of the fibrous anulus (Artificial Annulus) (made of polyethylene) and pulposus nucleus (Artificial Nucleus) (made of polycarbonate-urethane) 33 16 july 2018 www.revdesportiva.pt survival remain unclear. 3,5 This issue is of particular importance in the competition sports practitioners, in which a quick return to the sport is intended, preferably at the same functional level prior to the develop- ment of the condition. The fact that most of the time the disc prostheses are applied in young people, who will probably continue to practice sporting and consequent loads on the disc prosthesis for several years, may jeopardize the integrity of the arthroplasty, however these data remain to prove. 5 Siepe Cj et al. prospectively studied 39 practitioners from several sports (average age 39.8 and interval 26.2-58 years) that underwent lumbar disc arthroplasty (Figure 3), with an aver- age follow-up time of 26.3 months (interval 9-50.7 months). 3 They found out significant symptomatic improvement in all patients (average decrease of 5.7 on the vi 7V66RB3RFV7&V6R7vW7G'F6&ƗGFWFR'F&7FW0vW&RVWfV"2RbFR6PBFR&VrvW&R&WfVvFFR7BffV7FVBWfV2&VrBPBR3FR6W67&FW&6VB6VFR&RFRbFPfvr&WV&VVG37'G2&2ЧF6Rg&WVV7WVF"w&VFW FGv6RvVV&Vf&RBgFW 7W&vW''F6F6F7@"v7B7'G2&fW76FWFW2"6֖"FRf6P6VFVB&7FFW'2bf&W07'G2vFf&W2WfV2b7FfGg&&V7&VFF&fW762FR&WGW&F7G267W'&VBRPbFRFWFW2BB67W'&VBGW&pFRf'7BF&VRF23RR@&WGvVV2BbF23rPbFR6RvFFRV