The new target audience for joint replacement surgeries: the 40-year-olds

The average age of those undergoing hip or knee replacement surgery is decreasing. As the average life expectancy increases, many Americans are no longer willing to give up decades of enjoyment of their favorite activities, such as skiing, hiking or playing pickleball, for the pain associated with them, doctors say. And staying fit in your 50s and 60s is good for your physical and mental health.

Certain intense, high-intensity fitness activities can increase the chance of injury and arthritis—leading to the need for more medical procedures.

“In the past, people would just say, ‘I don’t run, I have knee problems,'” says Dr. Ren Schwarzkopf, an orthopedic surgeon at NYU Langone. Now, he says, “they’re not willing to give in to the limitations of arthritis.”

Another reason why young people are undergoing joint replacement is the growing prevalence of obesity in the US. More than 40% of US adults are overweight, says the Centers for Disease Control and Prevention, up from about 30% in 1999. Excess weight puts increased pressure on the joints — about four pounds (about 1.8 kg) for every additional pound of body weight — leading more patients to need replacements earlier in life.

For patients aged 45 to 64, there was a 211% increase in inpatient hip replacements and a 240% increase in inpatient knee replacements between 2000 and 2017, according to data from the US Agency for Healthcare Research and Quality of the Department of Health and Human Services (records after 2017 less accuracy, due to changes in Medicare coding). There was also an increase in joint replacements for patients aged 65 to 84, but it was not as dramatic.

This tracking does not include the growing number of replacement procedures performed in outpatient clinics, which allow patients to return home the day the procedure was performed. More than one million hip and knee replacement surgeries are performed in the US each year.

“You’re too young for that”

The procedures include replacing damaged or worn bone and cartilage in the hip or knee joint with artificial implants. Plastics have improved, which has helped replacement joints last longer on average, so surgeons are generally less wary of using them on younger patients.

“In the old days, patients were told they had to wait until they were 70 or 80 years old to have this procedure because the implants didn’t last long enough,” says Dr. Antonia Chen, an orthopedic surgeon at Brigham and Women’s Hospital. “Now, the implants Lasting 20, 25 or 30 years, and quality of life is much more important.” Chen estimates that patients under the age of 65 make up about 50% of her treatments now, compared to about 30% in 2014.

Procedures are now more efficient, with the help of robotic assistance and 3D printed custom prostheses. Also, advances in physical therapy, anesthesia and the administration of pain medication have led to shorter recovery times for patients. Many patients who would have spent days to weeks in a hospital bed can now walk the same day.

Carol Pope knows that at 37, she’s not the typical person people imagine when they think of a procedure like a hip replacement. “The two things I heard the most were, ‘Wow, you’re young for this,’ and ‘My grandma’s hip surgery went great!'” she says.

Pope, a financial advisor and avid runner based in Lakeland, Florida, first felt a twinge of pain along her back and legs at the starting line of a half marathon in January. She finished the race without incident, but the pain returned and spread. A doctor diagnosed her with osteoarthritis and told her she would have to stop running.

Losing her favorite hobby was like grieving someone close who died, she says. Her hope was renewed when an orthopedic surgeon agreed to schedule her hip replacement for September. “I’m looking forward to doing this so I can get my life back,” Pope says.

Not preventive care

Dr. Kevin Stone, an orthopedic surgeon at the Stone Clinic in San Francisco, encourages patients to exercise after recovering from surgery. As the author of a book called “Play Forever,” about how people with injuries and arthritis can keep moving, he says the more active you are, the better. better

“Our goal is for people to die at 100 while playing their favorite sport,” says Stone.

Many still recommend minimizing or completely avoiding running and high-intensity exercise after surgery, as this can put additional stress on the prostheses. Our joints are like tires, surgeons say. The more weight the tire carries, the faster it wears.

These procedures are largely unnecessary, and surgeons caution that they should not yet be considered prophylactic. They carry risks including infection, dislocation or joint instability. Doctors generally agree that surgery is the logical procedure when the pain is chronic and limiting, affecting daily decisions. For example, if you use the elevator instead of walking up one flight of stairs, or you forego a vacation plan for fear of pain, it may be time.

Before surgeons can recommend the surgery — which usually requires insurance coverage — patients have to show they’ve tried other possible solutions, such as physical therapy, weight loss and cortisone injections.

Younger patients often assume that they will have a faster and smoother recovery. However, surgeons say active people can be more likely to push themselves too far during recovery. In addition, they can adapt more to the new joint over time and have more years to wear it. Some studies indicate that the younger patients are more likely to need repeat surgery at later stages.

Dave Erickson, a gym owner in Sparta, Wisconsin, hoped the hip replacements he had at age 46 would allow him to return to his regular exercise routine and last for decades. But just five years after his surgery, a bicycle accident brought him back to the operating room, and his right prosthesis needed repair.

He has lost significant range of motion in his right leg, and although he still exercises, he avoids certain exercises, such as squats and knee bends.

“When you’re older and you can barely walk, and suddenly you can walk, it’s an improvement,” says Erickson, now 54. “When you’re doing squats at the gym and running and then you have a hip replacement and can’t do all of that anymore, it’s not so good.” .