Why Younger Patients Are Opting for Joint Replacement
Within recent years, the number of joint-replacement surgeries has gone up, but not just among the older population. The number of Americans choosing joint-replacement surgery is increasingly moving toward a younger demographic.
Research presented at the annual American Academy of Orthopaedic Surgeons (AAOS) meeting in 2018 showed a drop in the average age of patients undergoing hip-replacement surgery from over 66 to just under 65, and the average age for knee-replacement surgeries declining from 68 to just under 66 for the 2000 to 2014 time period. Research has also found an increasing number of Americans living with an artificial hip or knee.
According to the AAOS, there was a 188 percent increase in knee replacements and a 123 percent increase in hip replacements for patients age 45 to 64 from 2000 to 2009. In comparison, knee replacements increased by 89 percent and hip replacements increased by 54 percent for patients age 65 to 84 during the same time period. Researchers note that the rates of younger patients seeking hip and knee replacements show no sign of slowing down and suggest continuing high levels of patient confidence in surgical intervention.
Although the news is encouraging, Venkat Rapuri, M.D., orthopedic surgeon and physician on the medical staff at Texas Health Arlington and Orthopedic Medicine Specialists, a Texas Health Physicians Group practice, knows all too well that joint replacement at a younger age comes with a few tradeoffs.
“There are a lot of patients who come to see me with knee arthritis at a younger age, asking if they can have a knee replacement so they can get back to their running or jogging activities,” he says. “One of the things I always say to patients is that knee replacements and hip replacements are like buying a new car. If it’s got 250,000 miles in it, is it going to last you 20 years or is it going to last you five years? Well, that kind of depends on how you spend those 250,000 miles. If you get back to running [after a joint replacement], it’s like trying to finish your joint off in five years instead of 20 years. These are not designed for running and jogging, unfortunately.”
The good news is that improvements continue to be made in the implant products in use. The current generation plastics used for joint replacements have increased resistance to wear and tear so greater longevity of implants is being seen. Although technology has improved over the years, with most hip and knee replacements lasting 15 to 20 years, the longevity of artificial joints has yet to be fully assessed in younger patients and revision surgery becomes a looming problem, especially if the patient returns to strenuous physical activity.
“When younger patients get a knee replacement they behave differently because they are a lot more active on their knees, so they go back to activities such as tennis, golf, skiing, and so forth, which is probably why they had the knee replacement in the first place—because the cartilage wore down. If you expect to return back to those activities and you don’t expect the joint to wear out … it is going to wear out quicker.”
Find an Approach That’s Right for You
According to a study by the Physical Activity Council, more than half of Generation X and over a third of Baby Boomers regularly participate in fitness activities. With fitness sports and outdoor sports being the most popular activity among the two generations, Rapuri is understandably consulted by many patients who are not willing to give up the highly physical activities they’ve come to enjoy.
“[For those patients] I go down the conservative route and I tell them ‘yes, knee replacement is an option, you can get it, but if you get it done, you can’t go back to sports such as singles tennis, running, cross-country skiing, jogging, basketball, volleyball—activities that involve jumping’,” he says. “If they are able to make those lifestyle adjustments, or are dead-set on getting a joint replacement, then I don’t mind doing it. But if they aren’t willing to make those lifestyle changes, then I recommend going the conservative route as long as they can bear with it.
All I can do is advise them and put the facts out there, and let them make an informed, educated decision. After a joint-replacement surgery is done, it’s not like a person is forbidden from doing any activity. I actually tell the patient to be active and enjoy a reasonably functional life. Do cycling, do elliptical machines, do walking, travel everywhere, play doubles tennis, do gentle skiing — choose something else that is enjoyable but less stressful on the joints,” he adds.
Although receiving a joint replacement does have its limitations that some young patients might not be willing to accept, there is a plus-side to having it done at a younger age: Younger patients have a lower risk of pre- and post-surgery complications, and the recovery time is usually much quicker.
“The length of stay at the hospital for knees, as well as the hips, has decreased phenomenally. A lot of surgeons are now doing single-day joint-replacement surgeries,” Rapuri explains. “Not everybody is a candidate for it, but the younger patients are more likely to be discharged on the same day after a joint-replacement surgery. The older you are, the longer you take to recover and bounce back. Also, the risk of comorbidities goes down. So, it does make sense to get it done when you’re younger.”
Know Your Treatment Options
For those who are not ready to give up high-impact activities, alternative treatments include:
- Over-the-counter medication to reduce pain, swelling and inflammation
- Physical therapy and/or light exercise to improve movement and strength
- Weight loss
- Electrical stimulation to strengthen muscles
- Steroid or biologic injections
The trend toward the use of biologics such as a patient’s own stem cell and platelet-rich plasma (PRP) for injection in treating early stage arthritis and osteoarthritis is one Rapuri believes will continue to grow. But, he notes that orthopedists are aware of the limitations of biologics in treating advanced stage arthritis.
“The AAOS and American Association of Hip and Knee Surgeons advocate and support research in the treatment of early arthritis using biologics. However, those in the field also understand their use in advanced stages has shown to cause unnecessary delay in the care of the patient, as well as unnecessary expenses.”
If you’re considering a joint replacement, but still on the fence, Rapuri says to keep in mind that there are two goals when it comes to joint replacement: relief of pain and the ability to return to enjoying the activities that you were enjoying before.
“The younger population who is maybe not ready to come to terms with changing their lifestyle probably needs to consider newer treatments on the horizon,” he says. “If they ultimately consider joint replacement, they need to be aware that there will be limitations, certain activities to avoid that won’t make their joint wear out faster. The upside is you can always find alternative activities that you can enjoy and still get joint pain relief.”