Interviewer: Hi Dr. Amanatullah, thank you so much for joining me here today once again. How are you doing again?

Dr. Amanatullah: I’m doing great. Thanks for having me again.

Interviewer: Absolutely. It’s my pleasure! So today we’re looking to do a little bit of talking about joint replacement in young athletes. So as you’ve previously discussed on other podcasts in this series, when it comes to your joints age seems to mean something a little different from what people usually seem to think. Especially when it comes to athletics people have joints that act much older than the person actually is just because of the wear and tear of the joints utilized in the practice. Could you just elaborate a little bit more on this for us?

Dr. Amanatullah: Yeah, so it’s very interesting. We do do joint replacements on patients who are younger and younger, and they demand more and more and more out of their joint replacements. I have martial artists, surfers, people who play golf, people who play competitive tennis, people who do all kinds of things, uh, in their normal routine. Competitive cycling, etc. So, it is really possible to perform at high levels with a joint replacement, um, but there are some caveats that are really important to discuss with the patients because it’s a special class of patients that do really well with, uh, getting ready mentally for a joint replacement that might perform well in sport.

Interviewer: Absolutely. What would you say are some of the mental preparations that a young athlete might have to do when going into a potential joint replacement?

Dr. Amanatullah: Yeah, so I think that the most important thing to consider is that the joint replacement that they’re receiving actually wasn’t made to do the thing that they’re gonna demand of it. What does that mean? That means that if um, if they’re not prepared to give up their sport to start, it might not be worth doing the joint replacement cause the joint replacement might not be able to give them the sport. So let’s say if you were a um, a…who did I have recently? Um…I had a someone who wanted to do competitive cycling. And so we discussed his hip pain and said, “Well, the joint replacement could have all sorts of complications when we put it in. It could perform really really amazingly or it could, and it’s very hard, very patient-dependent, he’s super motivated. He wants it to be done, but his pain’s so bad that he can’t cycle anyway. So, he wants to return to cycling. I think it’s fine for him to return to cycling on his hip but nobody’s really studied how many people can return to competitive whatever sport the patient picks — in this particular case cycling. So, if the patients has no other way to participate in their sport but yet wants to get back to that level of activity, that patient is both motivated, understands the risks, and understands the limits of a joint replacement. They’re in the best position to take advantage. If the joint replacement doesn’t get them there they get the benefit of trying, and they get a pain-free joint. If they get there then they get amazing performance out of it anyway, but it’s impossible for the surgeon actually to know because our criteria are so..mmm what’s the word? Crude? Meaning I can test-drive your hip on the table but it’s impossible for me to know ultimately it’s overall performance because I don’t actually know what competitive cycling means to that person. I don’t live in their shoes and know how much they want out of it. All I can do is get them the best performing hip when they’re asleep. And that creates this discrepancy between performance and surgery.

Interviewer: So what are some of the measures that doctors are taking in your field when performing surgery on like a younger patient who is an athlete?

Dr. Amanatullah: Yeah so, you know obviously we’re gonna pay a lot of attention to alignments. We’re gonna pay attention to balance. We might use a special instrument that helps us assess the balance of the knee to make — oh and then of the hip we’re gonna do appropriate attention to the position of the components, take the hip through the extremes of range of motion and make sure that it doesn’t impinge on any of the parts so that there’s no, or we decrease the risk of dislocation. We’re gonna make sure there’s no soft tissue impingement, meaning the parts we can’t see on x-ray might bump into each other as well. We’re gonna take the knee through a range of motion to optimize that range of motion as well. We’re gonna pay really close attention to the soft tissues which are — and how they’re closed and how they’re opened because it’s the damage to those soft tissues ultimately that’s probably even more important than the joint replacement when we talk about recovery and function.

Interviewer: Absolutely. So what advice do you have for young athletes who are going in for some joint surgery in their future?

Dr. Amanatullah: I would, I would give my previous cautionary tale which is that joint replacements aren’t made for athletes. We happen to get some athletes who have amazing performance out of their joint replacements. Unbelievable performance. But that, understanding the risks and understanding the limitations of a joint replacement first, and then the desire to perform at an extremely high level of activity second. If it’s the other way around I think patients set themselves up for a large amount of disappointment in this particular setting because a joint replacement is a salvage for a…an athlete per say. Because it wasn’t made for them. We use it for them. It was made for someone to walk around pain-free and you know do normal activities of daily living, but when we talk about more than that? It’s an important thought process both on the surgeons end and on the patients end.

Interviewer: Absolutely. Great well this is all the time we’ll have today but thank you so much again for making time in your busy schedule Dr. Amanatullah to have this great podcast, keeping going and up and running. We always appreciate the information that you come to the table with, and we always leave learning so much more.

Dr. Amanatullah: Thanks so much. Anytime!

Interviewer: Thanks again.