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Pushing the boundaries? Challenges and ethical considerations for hip and knee joint arthroplasty in elite athletes
  1. Géraldine Martens1,
  2. Charles Pioger2,3,
  3. Renaud Siboni3,4,
  4. Matthieu Ollivier5,
  5. Jean-Marie Fayard6,
  6. Patrick Djian7,
  7. Jean-Noel Argenson5,
  8. Patricia Thoreux8,9,
  9. Romain Seil3
  1. 1 Physical Medicine and Sport Traumatology Department, Central University Hospital of Liege, Liege, Belgium
  2. 2 Department of Orthopaedic Surgery, Ambroise Paré University Hospital, Boulogne-Billancourt, France
  3. 3 Department of Orthopedic Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
  4. 4 Department of Orthopedic Surgery, Hospital Maison Blanche, Reims, Champagne-Ardenne, France
  5. 5 Institute of Locomotion, Hopital Sainte-Marguerite, Marseille, Provence-Alpes-Côte d'Azur, France
  6. 6 Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
  7. 7 Chirurgie Orthopédique et Traumatologique, Clinique Nollet, Paris, France
  8. 8 Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Université Sorbonne Paris Nord, Paris, France
  9. 9 Pôle Médical, Institut National du Sport, de l'Expertise et de la Performance, Paris, France
  1. Correspondence to Dr Géraldine Martens, Physical Medicine and Sport Traumatology Department, Central University Hospital of Liege, Liege, Belgium; geraldine.martens{at}

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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 osteoarthritis (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 …

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  • Contributors GM and RSe drafted the manuscript outline. GM, RSe, CP and RSi wrote the manuscript. CP, RSe, MO, JMF, PD, JNA and PT critically reviewed the manuscript for intellectual content. All authors approved the final version of the manuscript.

  • Funding Part of this work was supported by the International Olympic Committee Medical and Scientific Commission through the IOC Research Centres Network.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.