NFL athletes had high prevalence of TKA after retirement
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Retired National Football League athletes had a higher prevalence of knee replacement compared with hip replacement, with age and severe joint injury identified as risk factors for both knee and hip replacement, according to published results.
Researchers collected a general health survey examining lifetime playing, medical and concussion history, musculoskeletal injury, health status, nutritional and substance abuse background and demographics for 2,432 retired male NFL players. Researchers assessed the association between self-reported playing or injury history and replacement after retirement with prevalence ratios, and adjusted models for potential confounders of age and weight.
Results showed 11.4% of participants reported undergoing joint replacement after retirement. Researchers found 7.7% and 4.6% of participants reported undergoing knee and hip replacements, respectively. Previous severe knee injury was reported by 53% of participants, with 32.2% of participants reporting a previous meniscal tear, according to results.
Multivariable models showed an association between knee replacement with age, current weight and reporting one, two, or three or more knee injuries. Similarly, researchers found an association between hip replacement and age, position of play as a lineman and reporting one, two or three or more hip injuries. Results showed a cross-sectional association between replacement after retirement with each reported knee injury type.
“While the findings represent an elite retired NFL playing cohort, they also substantially improve our current knowledge of long-term musculoskeletal health in NFL and collision sports more broadly,” the authors wrote. “Further study is recommended to identify and differentiate among the potential onset of joint pain, physician-diagnosed [osteoarthritis] OA and joint replacement surgery and to increase the precision of injury counseling and clinical management, with a view to longer-term player welfare.” – by Casey Tingle
Disclosures: Davies reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.
Perspective
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Shane J. Nho, MD
Knee or hip joint replacements are effective but major procedures for end-stage osteoarthritis. The risk factors for development of OA are well known and include age, obesity and prior joint injury. While there are many benefits of competitive athletic involvement, football — as a collision sport — carries intrinsic risk. Nonetheless, football is an incredibly diverse sport with physiological requirements and risk to injury varying substantially depending on player position.
The cross-sectional study by Madeleine A.M. Davies, DPhil, and colleagues included an impressive 2,432 retired NFL players with careers across 12 different positions. Despite the young average age of the cohort relative to a diagnosis of OA (53.6 years), the prevalence of hip and knee replacement was 4.6% and 7.7%, respectively. The risk factors for both hip and knee replacement were increased age and joint injury, with the number and type of joint injury associated with higher prevalence of joint replacement. Increased weight was associated with increased risk of knee but not hip replacement. Interestingly, years of play did not affect joint replacement risk. Unsurprisingly, playing as a lineman, a high contact position, was an independent risk factor of hip replacement.
Player welfare is always top of mind for orthopedic surgeons when caring for professional athletes. NFL careers are notoriously short, which makes the precision of injury counseling and clinical management critical. This study highlights several points of intervention among this high-risk population.
Division of sports medicine
Rush University Medical Center
Jonathan Rasio, BS
Division of sports medicine
Rush University Medical Center
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