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Total Joint Replacement- Timeline and Considerations for Pickleball Players

Total Joint Replacement (TJR) as a treatment for Osteoarthritis has become very common, and the prevalence of TJR is on the rise as baby boomers get older. The most common types of Total Joint Replacement are Total Hip Arthroplasties (THA) and Total Knee Arthroplasties (TKA). Both procedures have improved over the past decade, enabling people to return to higher levels of activity. Pickleball players are not exempt from knee and hip pain, and many undergo surgery in hopes of returning to the courts. Other TJRs are shoulder replacements and ankle replacements, which are not as common.Everyone has heard of the phrase “bone on bone,” which can scare people, as it’s usually the first step toward a joint replacement. Joint replacements can be very effective, but don’t always have to be the first approach to your “bone on bone” problem. Here are some considerations prior to opting for surgery:

1.You may not need surgery. Physical Therapy (PT) for mildto moderate osteoarthritis has shown to be very effective, and may extend your ability to remain active prior to needing surgery. Just because you are “bone on bone” doesn’t necessarily mean you need surgery. Try PT first and then reassess your options.

2.Maximize your fitness level by doing Pre-Hab PT to increase your strength, mobility, flexibility and motor control. All these will put you ahead of the curve for when you have surgery. The more fit you are before surgery, the better you’ll come out of it, making your post-surgery rehab more successful.

3.Joint replacement rehabilitation is not easy. The surgery is just the first step. If you plan to continue playing pickleball, be prepared to work hard following your surgery. If you’re not willing to commit to your rehab program and work through some pain following surgery, this may not be the best option for you.

4.While joint replacements aim to decrease your current pain, please know there will be pain following the surgery.This will decrease over time, but can take three to six months (sometimes a year) to resolve. Most people will get back to playing pickleball at six months post-op, but it can take up to a year to fully regain the necessary strength and motor control to play your best pickleball without pain.

I often treat patients who have expectations for their total joint replacements that are not necessarily realistic. It’s important you know what you’re getting into and understand that surgery is just the beginning. The following is based on my experience as a Sports Physical Therapist:

Total Hip Replacement
Overall, this is probably the best joint replacement in terms of outcome. The hip is a very stable joint, and the advances in surgical techniques have made this procedure very successful overall. However, it’s a major procedure. The head of the femur is displaced out of the socket, then the head of the femur is cut off and a metal rod (prosthesis) is inserted inside the femur. A new joint socket is then placed before relocating the head of the femur back in place. Patients are usually walking within the first day or two, and will start physical therapy as soon as possible. The pain is not as bad as a knee replacement overall. A thorough hip strengthening program, as well as extensive mobility and flexibility work, is crucial in order to return to playing sports.

Total Knee Replacement
This is the most common procedure, and the outcome varies for each person. Being diligent with your rehabilitation is a must if you wish to get back to playing pickleball. Again, this is a major surgery, with both the femur and tibia being cut, as well as the undersurface of the patella being scraped. Recent advances are making it possible to retain internal ligaments of the knee (ACL and PCL), which may improve the function of the knee in the long run and provide increased stability. Patients should be ready to endure a fair amount of pain following surgery. Working on range of motion and regaining full extension is vital for this procedure and for normal function. Patients can expect to be back on the court within six months (not 100 percent), and back to normal after about a year.

Total Shoulder Replacement
Overall, shoulder replacement seems to leave people a bit disappointed. When pain is taking over your life and the shoulder is just not usable, then a shoulder replacement may be beneficial. However, I’ve seen people struggle with the rehabilitation after this procedure. It’s difficult to get full range of motion back, which can affect your ability to play pickleball. It works well for some people, but be prepared for a difficult rehab. Once again, focusing on motion, flexibility and mobility is key in the first few months to ensure you can move through the entire range of the shoulder. Reverse total shoulder replacement is another procedure that’s usually used when someone has little or no rotator cuff stability. It’s not ideal for getting back to pickleball.

Total Ankle Replacement
This is not as common, and overall appears to be restrictive in terms of motion following surgery. A difficult rehabilitation is ahead, and I wouldn’t rush into this procedure unless you have to. The ankle is a joint that requires good stability and mobility, which can be very hard to get back.

If you have any questions, you can contact the Pickleball Doctor at thepickleballdoctor@gmail.com.

Noe Sariban is a Doctor of Physical Therapy, Certified Pickleball Teaching Professional through the IPTPA, and a USAPA-rated 5.0 player sponsored by Engage Pickleball. Please visit www.thepickleballdoctor.com for more information on injury prevention and rehabilitation tips. Noe started his website to provide pickleball players around the world with a reliable and free source of information. Please like his Facebook page, www.facebook.com/pickleballdoctor, for updates and new information.

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