Can growth hormone improve healing and recovery after joint replacement surgery?

Growth Hormone Does Not Improve Healing and Recovery After Joint Replacement

Growth hormone is not recommended for improving healing and recovery after joint replacement surgery as there is no reliable evidence supporting its efficacy for this purpose. 1

Evidence Against Growth Hormone Use in Joint Recovery

The available evidence does not support the use of growth hormone to enhance healing after joint replacement:

• In the only study of growth hormone in patients with chronic obstructive pulmonary disease (COPD), despite an increase in lean body mass, there were no improvements in muscle strength or functional capacity. In fact, 6-minute walk distance significantly decreased in the growth hormone group compared to placebo. 1

• Studies examining growth hormone's effects on tendon and ligament healing (which are relevant to joint recovery) have shown:

  • Human growth hormone administered to human tendon and ligament fibroblasts did not positively affect cellular proliferation or differentiation 2
  • In a rat model of acute tendon-bone injury repair, daily subcutaneous postoperative human growth hormone treatment failed to demonstrate any significant improvement in biomechanical parameters compared to placebo 3
  • More concerning, longer-term administration of growth hormone (pre- and post-operatively) actually demonstrated lower loads to ultimate failure and higher risk of bone fracture compared to placebo 3
  • Growth hormone did not stimulate tendon healing in rat Achilles tendons despite having stimulatory effects on other tissues 4

Current Recommended Approaches for Joint Replacement Recovery

Instead of growth hormone, current guidelines recommend the following evidence-based approaches for optimizing recovery after joint replacement:

Pre-operative Preparation

• Exercise programs before surgery to strengthen muscles 1
• Weight management for overweight or obese patients with hip/knee OA 1
• Patient education and self-management programs 1

Surgical Considerations

• Total joint arthroplasty is preferred over hemiarthroplasty for glenohumeral osteoarthritis 1
• Consider surgeon experience - higher volume surgeons have lower complication rates 1

Post-operative Recovery

• Early mobilization on the day of surgery (≥3 meters) 5
• Immediate postoperative physiotherapy 5
• Appropriate pain management with multimodal approaches 1
• Physical rehabilitation for all patients to address muscle weakness 1

Important Caveats and Considerations

1. Potential Risks of Growth Hormone:

   • Side effects of growth hormone administration can include lipid abnormalities, polycythemia, and liver function abnormalities 1
   • In older men, there are concerns about enhancing growth of subclinical prostate cancer foci 1

2. Enhanced Recovery After Surgery (ERAS) Programs:

   • Implementation of comprehensive ERAS programs has shown benefits in reducing hospital stay while maintaining quality of recovery 5
   • Key components include antiemetic prophylaxis, tranexamic acid use, early physiotherapy, and early mobilization 5

3. Alternative Approaches:

   • For patients with persistent pain or functional limitations after joint replacement, conventional rehabilitation approaches should be optimized before considering experimental interventions 1

In conclusion, despite the theoretical appeal of using growth hormone to enhance recovery after joint replacement, the current evidence does not support its use and suggests potential harm. Clinicians should focus on established evidence-based approaches to optimize outcomes after joint replacement surgery.