joint surgeries and diving

[rhwestfall]

Well, I asked my GP and my Ortho, and neither had any thoughts....

History: 45 year old male, former collegiate level athlete. The years have taken their toll, resulting in surgery on each knee (scope fork - torn meniscus, and cartilage repair/removal), and also, recently (a week ago) repair of a SLAP tear in a shoulder.

Diving instruction, as well as the never ending releases keep listing surgeries, and my recent readings in Powell's Deco-For-Divers continues to stress injury sites being a potential for issues.

I dove for years pre-surgery, after an absence from the sport, I am returning, hoping to be fairly active.

What are the best management practices to continue diving with this history? What should be of specific importance to keep aware of?

Thanks for any opinion (not to be taken as professional advice).

Bob

 

[Duke Dive Medicine]

Bob,

In theory, impaired circulation to a joint as a result of injury can increase the risk of DCS. The most-often cited example is recent soft tissue injury, which can result in tearing of capillaries and subsequent compromise of blood supply. Most of your injuries appear to be to cartilage, which does not have a blood supply to begin with. I'd say a bigger risk for you would be impaired strength and range of motion, which you can minimize by adhering to your PT regimen. Of course your surgeon has the final say, but it's not unreasonable to predict that you could resume diving as soon as you're cleared for full activity.

Best,
DDM

 

[TSandM]

To my knowledge, there are no real data to show that surgical sites are at higher risk for DCS. The concern is theoretical, that the circulation in the area of injury is not as good as it was before the injury or operation occurred.

I have looked for any papers citing a high incidence of DCS in people with fractures or operations, and have found none.

My personal experience is after 23 fractures and 7 major operative fixations, as well as a splenectomy and hysterectomy, that I have completed almost 1000 dives, including some staged decompression dives, without any symptoms in any of the operative sites, other than those related to degenerative arthritis and the stress of carrying gear. That's anecdote, not data, but perhaps it will be reassuring.

 

[Duke Dive Medicine]

My personal experience is after 23 fractures and 7 major operative fixations, as well as a splenectomy...

Sending you a hockey helmet and a roll of bubble wrap

 

[boulderjohn]

I don't have the medical knowledge of the previous posters, but I do have some knee damage thoughts you might find useful. Like you, I beat my knees up pretty badly. I had a football injury while in college, and then I beat them up through skiing, competitive volleyball, and basketball throughout my adult life. Well before I was your age, just walking was painful, and I had had several surgeries such as you describe. That is the main reason I got into diving--it was so much easier on my knees than my other avocations.

But my knees still got worse, and one knee in particular forced me to walk with a painful limp (and eventually a cane) all the time. I kept asking about knee replacement, but my GP was adamant that I was too young for it. He said they wear out and leave you a young cripple. I finally summoned the courage to ask for a second opinion. He gave me the names of two very conservative orthopedists, and I selected another on the recommendation of a friend. Two of them (including the one I selected) recommended immediate knee replacement, but it was the one who didn't who convinced me to do it. He didn't use quite these words, but he said in essence that I should live as if I were a very old man (buy a one story house; always use elevators and handicapped parking; use a cane, stop all active sports, etc.) until I was a very old man, at which point I could get a knee replacement and act my age. I decided that with only a limited time left in my life for "youthful" activity, I was not going to waste them sitting on a couch.

So I got a knee replacement about 5 years ago, and it was one of the smartest moves I ever made. I have no pain in that knee whatsoever. If I can get someone to help me stand up, I can walk to the back of a boat carrying steel 108 doubles, an AL 80, 2 AL 40s, and all related gear and then jump in the water without pain.

I asked my orthopedist how long I could expect the replacement part to last. He said he had no idea. He had only been doing it 20 years, and so far there had only been a 5% failure rate. The model knee he uses has the ability to be opened up and have a replacement part inserted, so that 5% is essentially back again with new parts. He also said that the materials used today are significantly better than they were only a few years ago. If my knee fails in a quarter century, I can get a "tuneup" and be back in operation again. Of course, the odds are I will be dead by then.

My other knee is starting to go bad, but it is still very manageable. When it is time, I won't hesitate about getting a new part.

 

[herbdb]

The wonders of modern medicine! I had both hips replaced 8 years ago. Still doing well. Without the surgery, I would be using a chair lift for stairs and getting around in a scooter. I easily stand and walk with a steel 120 and wts. My biggest issue is getting fins on and off due to reduced flexibility.

 

[boulderjohn]

My biggest issue is getting fins on and off due to reduced flexibility.

I feel your pain. To me the hardest thing about diving is removing my fins while hanging onto a bouncing ladder in ocean waves. It ia a moment I dread at the end of a dive.