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
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