Pushing the boundaries? Challenges and ethical considerations for hip and knee joint arthroplasty in elite athletes

Géraldine Martens 1,  Charles Pioger 2,3, Renaud Siboni 3,4

Matthieu Ollivier 5,  Jean-Marie Fayard 6, Patrick Djian 7,

Jean-Noel Argenson 5, Patricia Thoreux 8,9, Romain Seil 3

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1 - Physical Medicine and Sport Traumatology Department, Central University Hospital of Liege, Liege, Belgium

2 - Department of Orthopaedic Surgery, Ambroise Paré University Hospital, Boulogne-Billancourt, France

3 - Department of Orthopedic Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg

4 - Department of Orthopedic Surgery, Hospital Maison Blanche, Reims, Champagne-Ardenne, France

5 - Institute of Locomotion, Hopital Sainte-Marguerite, Marseille, Provence-Alpes-Côte d’Azur, France

6 - Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France

7 - Chirurgie Orthopédique et Traumatologique, Clinique Nollet, Paris, France
8 - Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Université Sorbonne Paris Nord, Paris, France

9 - Pôle Médical, Institut National du Sport, de l’Expertise et de la Performance, Paris, France

As the world of elite-level sports continues to evolve in parallel with the evolution of medicine, new and sometimes unexpected challenges keep arising. The duration of sports careers has increased along with life expectancy, as well as with sport training and competition loads. Sports activities may lead to a higher risk of severe osteoar- thritis (OA) in young patients due to discipline-specific factors such as high velocity/impact, frequent pivoting or repetitive joint loading.1 Therefore, specific medical attention and sometimes major surgical interventions such as total joint arthroplasty may be required in particular cases. Initially designed to improve quality of life during later decades of life, joint replacement surgery has been one of the most important medical achievements of the late 20th century. With many motivated young athletes pushing the limits to resume sports after surgery, the growing surgical expertise for minimally invasive procedures, and the evolution of implants, there is a trend for patients to undergo arthroplasty surgery at an increasingly younger age.2

In elite athletes, the risk of developing end-stage OA and undergoing arthroplasty is higher than the general population, often at an earlier age.1 3 Reports about the return to elite-level sports after joint replacement are scarce. A case series reported that elite athletes were able to resume sports activity at a professional level following hip resurfacing arthro- plasty, across a wide range of high-impact sports like tennis, soccer, track & field, and long-distance running.4 That series followed individual examples reported by the public press (eg, Andy Murray in tennis, Quentin Robinot in table tennis and Floyd Landis in cycling), thus receiving high media attention. It could be foreseen that sports medicine prac- titioners and orthopaedic surgeons will increasingly be faced by younger patients of various athletic levels expressing the desire to undergo hip or knee arthroplasty to continue their athletic careers at the highest possible level.