The Park and Your Health: A Conversation with Matthew Lorei, M.D., Chestnut Hill Hospital

Education // June 26, 2018

Dr. Lorei has had a long-term relationship with Wissahickon Valley Park. An FOW member, he discovered the Wissahickon soon after moving to Philadelphia for medical school. He and his then girlfriend/now wife would go for a run every Sunday on Forbidden Drive. Years later, that’s where his children learned to ride their bikes. Whenever he can, he loves to go trail running (the Yellow Trail is a favorite) with his dog. Dr. Lorei’s interest in orthopaedics started in fifth grade when he fractured his arm playing football. Today, he is Chief of the Division of Orthopaedic Surgery at Chestnut Hill Hospital, Chief of the Joint Replacement Service at Temple Hospital, and Associate Professor of Orthopaedic Surgery at Temple University School of Medicine. He was recently named a Top Doctor by Philadelphia Magazine.

Q. Are there any outdoor activities that are better or worse for joints?
A. In the absence of injury or known arthritis, there is very little evidence to suggest that any type of moderate, repetitive physical exercise is detrimental to joints in any way, even running on the more rigorous trails in the Wissahickon.

Q. Is arthritis in the hip and knee joint an inevitable part of aging?
A. No. Contrary to common belief, the wear and tear of aging does not necessarily cause degenerative joint disease (a.k.a. osteoarthritis). Most people will not develop significant hip or knee degenerative joint disease even if they live a long life. By age 70, only 1 in 4 females and 1 in 5 men will develop significant hip or knee arthritis. A strong genetic component accounts for the majority of cases. There are other risk factors that can predispose one to arthritis as well. With knees, it can be due to a major injury in youth or early adulthood that leads to deformity of the joint over time. Hip arthritis can be caused by a congenital or developmental abnormality, or because of a repetitive, sports-related micro-injury to the hip (e.g., football, ice hockey) in childhood, which can lead to arthritis later. Obesity is also a major risk factor for hip and knee problems

Q. How do I know if it might be time for a joint replacement?
A. Significant arthritis seen on an X-ray, where protective cartilage between the bones has worn away, is the most obvious indicator. Pain level is another significant determinant. If one or more of the following pain-related factors apply to you, it may be time to have a conversation with your physician about joint replacement surgery:

• Pain that wakes you from sleep at night
• Climbing stairs only one at a time
• Inability to walk more than block or two without stopping
• Needing a cane or other support to aid walking
• Regular limping
• Trouble standing at work, frequent need to sit down
• Difficulty doing the things you love to do because of joint pain

Q. After joint replacement, what form of exercise is best?
A. Following joint surgery, exercise that strengthens the muscles around the joint will reduce post-operative pain and increase performance of the prosthesis. Your physical therapist will help to guide you with appropriate exercises. Most patients are able to resume normal walking, without a cane, about six weeks after surgery. It’s best to start out on a flat, even surface like Forbidden Drive (avoid any hills) and limit your distance to a mile or two for the first month or so. My overall rule of thumb: Listen to your body. If it hurts when you do something, stop. If your joint is really sore the next day – you probably overdid it.

Q. For the long-term, what activities are recommended to preserve an artificial joint?
A. Artificial knees are cemented in place, so premature cracking, chipping or loosening (think of the grout in your shower) can occur with high stress activities. Hips don’t get loose, but wear is a potential issue. Therefore, to prolong the life of your joint prosthesis, walking is terrific, even on the more challenging Yellow or Orange Trails. You can also safely engage in other low stress (on the joint) activities, such as biking, golf, swimming, tennis –even cross-country skiing on Forbidden Drive – for the rest of your life with no deleterious effects on the joint. But high impact activities – distance running, full-court basketball, soccer – can possibly cause premature wear and loosening of the joint. Also, I generally discourage any activity with a high risk of falling.