You might prefer surgery than to give up triathlon. I did. I will however stop running after 8th April 2001 (this will be, or was, my last Ironman and only my second). Through surgery you may get a temporary lease of further life out of the joint, although of course this depends on the procedure. Osteotomies will keep the old joint but realign it so that the major load bearing points are changed to areas where there is a good cartilage surface. This kind of surgery is very invasive, very painful, and requires a long recovery period. In my case, as I’d expect in other cases too, the range of movement may be altered. I am no longer able to sit on the floor cross legged, so you had better work out with your orthopaedic surgeon just what kind of range of movement you can expect with the particular translocation or realignment that will be applied to the joint in question. Limb shortening and lengthening is also not uncommon. My right leg is now about 2cm shorter than it used to be but it used to be 1cm longer than my left anyway. This is a small discrepancy and has been easily accommodated with an orthotic wedge inside the heal of my right shoes.
Joint replacement procedures, with the current technology, means that it is all over from a sporting aspect. They really are for less active people and are more for pain relief and through this giving improve mobility. Although there are many different types of prosthetic replacement joints. Their construction and materials vary and some undoubtedly will be better than others. I have heard of athletes with hip joint replacements continuing to cycle and I know of two. One case appears to be still competing in audax events.
There is has been some experimentation with cartilage grafting. Some cartilage is extracted and then crushed up and a culture grown to produce more cells (this is called autologous chondrocyte implantation or ACI). These cells are then grafted or injected into the affected joint and the cartilage regrows and repairs itself. I have seen one case where this was used in a knee. I have yet to see more data and more cases.
There is new research with stem cells that shows some promise in the future of being able to grow replacement limbs and organs, how this can be adapted to joint replacement or repair is just beginnning to be seen. There has been some work with mesenchymal stem cells which has been successful in generating fibrous cartilage (mainly composed of type I collagen) which is useful for small defect repairs but is inferior to arcticular hyaline cartilage (mainly composed of type II collagen). Articular hyaline cartilage is what covers the ends of the bones in moving joints like knees and hips. It has spongey qualities and can take heavy load bearing, and provides a smooth surface for smooth and frictionless movement. Gene therapy is used to create hyaline like cartilage cells using transforming growth factors (TGF-B, TGF-S). In one case stromal cells, which would have become fat cells were transformed into chondrocytes, that is, cartilage cells – this has implications for ACI. Morphogens (such as rhOP-1 aka rhBMP-7) and how they are affected by modulators (such as Chondroleukin aka CL) appear to be the key to promoting stems cells to differentiate into chondrocytes, which looks promising and may well provide “self healing” capabilities for humans with respect to cartilage repair and regeneration.
As new treatments come to light I will update this section. By all means send me an email if you see or hear of any. Also check out the news page for any news or articles.
The Birmingham Hip Resurfacing (BHR) Procedure
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