No more bushwalking

[Strider]

A couple of mates of mine had knee replacements in their mid 20s. They are both now back to bushwalking, playing footy, etc. Definitely seek a second opinion.

I am very surprised by this. Not only such a young age but also that they would go back to playing high impact sports which seems to be always advised against.

Me too. How old are they now? Joint replacement in your 20's sounds pretty extreme.

Late 20s now, has only been a couple of years. That was the surprising bit for me too.

[icefest]

Caution: random anecdote.
I've been on the treating team of a third revision of a total knee replacement. The patient was in her early 50's and had a BMI of greater than 40. The surgeon told her that this was the last thing he'll be able to do for her and that unless she loses weight, she'll ruin this one.

In general, the orthopods that I've worked with (and whom I would trust to operate on me) prefer postponing the TKR as long as possible, as the technology is advancing so fast.
IMHO, the next great leap will be custom knee replacements (via 3d printers) and the one after that will be bio-integrated prosthetics.

[GPSGuided]

IMHO, the next great leap will be custom knee replacements (via 3d printers) and the one after that will be bio-integrated prosthetics.

I am a bit sceptical. "Custom", a label good for justifying a price hike on these devices . Though it will benefit a small sub-population but for the great majority, it's not going to be too meaningful. Fundamentally, it's still a stiff and "dead" foreign body. Attempts to make them less stiff and more bone compatible has just made them less durable. The "bio-integrated" term has been a beloved word for a long long time in the implant industry. I think we'll need a major paradigm shift in material before we'll see this in reality. Tough nut to solve.

[icefest]

I'm not sure how true that is, a better fitting replacement would mean that less time is spent with the knee open in theatre, getting the damn thing to fit, that makes the operation in itself cheaper. A decrease in invasiveness would also mean faster recovery. Lastly, a custom fit can be better balance to wear more evenly, and so hopefully last longer.

I'm still young though so I have a differing outlook on what the future might bring.

[GPSGuided]

I'm not sure how true that is, a better fitting replacement would mean that less time is spent with the knee open in theatre, getting the damn thing to fit, that makes the operation in itself cheaper. A decrease in invasiveness would also mean faster recovery. Lastly, a custom fit can be better balance to wear more evenly, and so hopefully last longer.

I'm still young though so I have a differing outlook on what the future might bring.

A lot of marketing exaggeration to support incremental improvements. If you add up the resolution errors of CT/MRI imaging (basis of these custom prostheses), tissue variability and human/robot assisted procedure, the customisation ends up not so finely tuned. Not as if the present inventory doesn't have a range of sizes to choose from. Given the life of such devices, it's a long road trying to prove an incremental improvement.

It's good to be optimistic and continue to strive for newer ideas in research. That must not stop. But it's also good to be wise and conservative and to maintain some scepticism when it comes to making a decision at the clinical end. With experience, you'll see certain words being branded around to suit the economic and policy environment of the day. It's ironic that "cheaper operation, cheaper medical care" has been talked about for a few decades now with numerous better and "cheaper" drug/procedures being invented. But the cost of medical care has not dropped. Quite frankly, with the amount of extra work involved in preparation and production of such a "custom" prostheses, it can not be cheaper. The increased cost will just suck up any hypothetical clinical savings, realised or not.

[jjoz58]

Sorry to hear about that it's becoming a more common occurrence. Nothing worse then having to stop something you love doing.

This is one of the reasons none of my physical training involves any impact work. I save all my walking for the bush. Lots of lower joint problems from the army that will only get worse with time.

Use trek poles and limit or no impact training and save your joints for old age.

[GPSGuided]

Use trek poles and limit or no impact training and save your joints for old age.

Unfortunately it ain't so simple. Bones actually need impact activities to stay strong. Without, it's easy to lose density ie. Osteoporotic, and that's bad in the elderly. If you are not afflicted by various health issues, moderation is ideal. Some impact exercises but not in excess.

[jjoz58]

I think I get enough impact in my daily life and I walk nearly every weekend I find that is enough. No need for me to do walks around the neighborhood or good forbid any running. I swim, bike and do wts plus use a cross trainer and rowing machine and for me that works. Keeps me fit.

[wayno]

ever thought about kayaking instead? stick as much camping gear as you like in a sea kayak, it won't wear out your joints...

[davidmorr]

Use trek poles and limit or no impact training and save your joints for old age.

But be careful because arms and shoulders are not intended to support your weight like legs are. Overdo it and you could have shoulder problems…..

[north-north-west]

ever thought about kayaking instead? stick as much camping gear as you like in a sea kayak, it won't wear out your joints...

...apart from the wrists, elbows and shoulders . . .

[farefam]

Yes, balancing the joy and freedom that comes from bushwalking with the resulting accelerated wear and tear to the knees, hips and lower back is a quandry.

I feel for you Tex; I'm not looking forward to the day when I eventually have to retire the backpack, and somehow I think 4WDing would be a poor substitute (but still far better than staying at home).

In my case, after two left knee arthroscopies and a lower back operation, I've found that using walking poles helps reduce the load on the knees a lot - particularly on descents and on moderate steepness climbs (I wish I'd started using them when I was in my twentys and I also wish I'd taken it easier on the steep descents when I was younger and seemingly bulletproof). With spring loaded poles I've not noticed any adverse affects on the wrists or shoulders). Even though these days I still carry much the same load in my pack, taking my time and reducing the distance I cover each day has been a big help.

I've found sea kayaking can be a good alternative to bushwalking, but over longer distances (say 30km per day) on multiday trips it can be hard on the shoulders (and on the lower back if your paddling technique or arm strength isn't up to scratch or if you can't use a sail on your kayak to decrease the effort needed). There's heaps of great sea kayaking adventures to be had in Tassie (coastal and on the rivers); but not so many near my home in WA. Surprisingly I've found paddling on the ocean to be less tiring than paddling on flat water (you can paddle down the swells and rest a bit as you rise up the next one).