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Mount Sinai Health Beat: Dealing with Knee and Hip Pain

September 11, 2013 09:50 AM
Welcome to the Mount Sinai Health Beat, a feature with the official medical provider of USTA Eastern, USTA and the US Open. Each month, the Mount Sinai Medical Center will provide tips to prevent nagging injuries from cropping up, which prevent players from competing in tennis. One of the world’s leading medical institutions, Mount Sinai’s experts are uniquely positioned to help athletes from professionals to club players succeed in sport.

In addition to providing on-site clinical care for the professionals competing in the US Open, Mount Sinai’s team of medical experts aims to lead the development of policies around injury prevention and to conduct educational outreach to promote the health benefits of tennis.  

This month, the topic is how to return to tennis after a hip or knee replacement with the advice of Dr. Darwin Chen, an Assistant Professor of Orthopaedic Surgery at the Mount Sinai Medical Center in New York.



Dr. Darwin Chen

Dr. Darwin Chen

Your knee aches. Your hip throbs. Discomfort in one of these joints may have started while dashing for that match point smash, but the sensation morphed into pain now felt off the court.

When should you check in with your orthopaedist?

"I tell my patients they should consult with their physician sooner rather than later," says Darwin Chen, MD, Assistant Professor of Orthopaedic Surgery at The Mount Sinai Medical Center. He is also a member of the Mount Sinai Joint Replacement Center team.

Joints typically fail due to osteoarthritis, which is caused by wear-and-tear usage over time.

Sometimes, an arthroscopic repair of a torn meniscus or another sports injury occurred earlier. "Eventually the reconstruction breaks down and the knee starts to give way, leading to accelerated wear and tear," says Dr. Chen.

Weight and fitness levels also play a big role in development of osteoarthritis, Dr. Chen adds. "A correct body weight puts less wear-and-tear stress on joints than does excess weight. And the stronger the supporting structures around a joint are, the more likely a joint can be preserved over time. They are less prone to injury."

Orthopaedists will first try cortisone injections, use of oral anti-inflammatory agents, and physical therapy before recommending other procedures. 

In the past, mainly older patients tended to seek out joint replacements. But Dr. Chen says he sees an increasing number of younger patients looking for treatment that goes beyond pain relief as well.

"Now we are treating substantially younger patients to restore function, and letting people return to the things they enjoy — such as a good game of tennis," Dr. Chen says.

If surgery is needed, good baseline physical fitness is a bonus, he says. "These patients typically leave earlier, get better faster, and are on the road to recovery much sooner than those who are not physically fit or are heavy."

Partial and Full Knee and Hip Replacements

For individuals with limited osteoarthritis, a partial knee replacement may be the perfect answer.

"The surgery is less invasive than a total knee replacement, and the resulting range of motion tends to feel absolutely normal," Dr. Chen says. "My patients with a ‘partial’ tell me that they forget that they had surgery, and that they return to any activity that they want."

Knee and hip replacements now last much longer due to improvements in the bearing surfaces — the areas that touch and wear on each other, he says. New, minimally invasive surgical techniques now lead to rapid rehabilitation and faster recovery, so that younger, in-shape patients can be back to playing singles matches within several months.

While half of all hip replacements are due to the same generalized wear-and-tear phenomenon, the other half can be attributed to hip impingement, says Dr. Chen. "This genetic condition produces a hip in which the ball–shaped femoral head is improperly formed, and does not fit neatly into the hip socket," he says. "Rubbing of the ball in the socket wears down the joint surfaces, leading to osteoarthritis that can show up in patients in their early 40s."

Young, active patients in need of a new hip may benefit from an anterior approach to the surgery, instead of the typical posterior approach, which is through the back of the hip, he says. "A posterior approach requires removal of some of the muscles around the hip, where as an anterior approach spares both nerves and muscles."

These patients may also receive ceramic-on-plastic implants "which offers both low wear and high durability," Dr. Chen says.

Recovery from hip replacement is generally quicker than rehabilitation of the knee, Dr. Chen says. "A hip has a single range of motion. A knee glides and rolls at the same time."

For hip, partial and total knee replacement, patients stay in the hospital 1-3 days post surgery, and use an assist device (a cane or walker) for the first two weeks. By six to eight weeks, patients are fully functioning.

Patients with a new hip can play light tennis at 6-8 weeks, and can go on to full activity with no restrictions at three months.

The recovery time is about the same, if not slightly longer, for patients with a partial knee replacement. "I usually let patients with a partial knee go back to sports at about eight to 12 weeks — gently at first, such as hitting a ball against a wall in the gym, or maybe playing doubles. Full activity, maybe even competition, is possible after three months," Dr. Chen says.

Individuals outfitted with a total knee replacement may return to full activity at four months. "It takes a little longer for the total knee to get to where a patient wants it to be because a ligament has to be scarified during the surgery," Dr. Chen says. "That is not necessary in a partial knee replacement."

"Joint replacement has come a long way in just a few years, and the future is nothing if not brighter. The bearing surfaces will continue to improve, leading to longer lasting joints," he says.

"It is well within reason to believe that a tennis player’s game will not suffer due to a new knee or hip — and it could improve with the absence of pain," Dr. Chen says. "Your new joint could, in fact, offer you a court advantage."


For more information on "Orthopaedic Surgery" and "Sports Medicine," click here.

Upcoming health tips include: Preventing and healing foot and ankle injuries with Steven Weinfeld, Spine problems that may emerge for tennis players with Andrew Hecht, Shoulder injuries with James Gladstone and Preventing tennis injuries in youth with Alexis Colvin.



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