Generally, hip and knee replacements are reserved as an “end of the line” treatment for mature adults who’ve been suffering with osteoarthritis, joint pain and reduced mobility for years. But where does this leave younger adults who’ve already reached their breaking point? In opposition to Hollywood’s film industry, would joint replacement surgery be considered reversed ageism? (This is just an unfunny joke). But really, where do the increasing numbers of men and women under the age of majority fit into the picture?
In 2014, the American Academy of Orthopaedic Surgeons (AAOS) reported that knee and hip replacements amongst 45-64 year olds have increased by 188% and 123% respectively.
Despite the success of joint replacement surgery, many surgeons turn away younger patients. For example, someone seeking a knee replacement at age 30 or age 40, or someone wanting a hip replacement at age 40 or even 50 may run into a brick wall. Now, this isn’t just to torture the young who’ve unfortunately been dealt premature, irreversible joint problems. Rather, orthopedic surgeons and clinicians postpone joint replacement surgery in order to get closer to the ideal situation: one joint replacement performed with zero revisions that lasts a patient’s lifetime.
Why Do Doctor’s Postpone Joint Replacement Surgery?
The main reason why your doctor will run through countless treatment alternatives before giving you the green light for a replacement is simple: artificial joints don’t last a lifetime. However, technological advancements in the artificial component materials mean that replacements last longer than ever. In saying this, the life expectancy on joint hardware is about 20 years. With nature taking its course, it’s likely that younger recipients will outlive their artificial joints and require a second or third replacement. This makes it clear why electing for a joint replacement is a major decision.
As four-time hip replacement recipient and PeerWell’s Head of Customer Success, Travis Schlueter-Beckner explains, “If you’re a younger guy or gal, your doctor doesn’t want to think you’ll need more than 1 or 2 surgeries in your lifespan. Every time you have a revision surgery you’re essentially lowering the bar on the healthiest you can be.”
Besides trying to buy time, here are reasons why your care team wants to delay a total joint replacement:
- You haven’t exhausted all alternative treatments yet. This means that you haven’t run through all recommended options when it comes to oral medications, injections, therapy and so forth.
- Let technology “catch up”. This is actually super important as leaps and bounds are always being made to the prostheses themselves. Who knows what the expiration date of tomorrow’s, even more advanced, replacements will be. Think about how much cell phones have advanced in the last decade! Amiright?
- Your general health makes an elective surgery more risky and complicated. If you have existing diseases or conditions (like diabetes) or habits (like smoking) that are uncontrolled, your doctor may not want to forward with an elective surgery. Being in good physical and mental health before surgery is a very important factor in determining how successful your outcome will be.
- Your care team would prefer your opt-in for another surgical procedure. When it comes to younger patients who would otherwise be candidates for joint surgery, orthopedic surgeons often recommend surgeries like High Tibial Osteotomy (HTO), Unicompartmental Knee Arthroplasty (UKA), or sometimes even Periacetabular Osteotomy (PAO) to postpone the need for a total replacement.
Let’s walk through the pros and cons to the alternative surgeries your doctor may suggest instead of a total hip or knee replacement. The best medical intervention for you is very individual. This information is meant to inform you, but always lean on your medical team for the best next move for your specific case.
Alternative Surgeries for Younger Patients
Determining when the right time for a joint replacement is can be hard enough for any patient, let alone younger adults who have to be realistic about how long an artificial joint can last. Here are some of the procedures that can delay your need for a total knee replacement. (Sorry, hip replacement peeps. There aren’t a lot mainstream surgical procedure that postpone a total hip replacement).
High Tibial Osteotomy (HTO) or Distal Femoral Osteotomy (DFO)
HTO and DFO are for younger patients who have unicompartmental (one sided) articular cartilage damage. In the surgery, bone is either removed or added to the tibia or femur. The procedure shifts body weight from the damaged part of the joint and reduces pain. By realigning the knee, body weight is transferred to the healthy, outer or inner parts of the knee. This slows the progression of osteoarthritis, letting you keep your natural joint for longer.
Pros: With this procedure, younger patients can engage in high-impact activities like jogging or tennis which are discouraged after a total or partial replacement.
Unicompartmental Knee Arthroplasty (UKA)
UKA, also known as a partial knee replacement, is becoming increasingly popular in the United States. Like a HTO, it postpones the need for a total replacement. However, unlike the HTO, a unicompartmental knee arthroplasty involves replacing damaged parts of the knee. There are 3 components of the knee, and if arthritis affects only one or two parts of the knee joint, a UKA can be a great choice. Like a total knee replacement (TKA or TKR), UKA is most common in patients 50 years and over. In order to qualify for a UKA, ligaments and undamaged parts of the knee joint must still be in place to support the partial replacement. When the entire joint is damaged, a total replacement is the only option.
Pros: Like a total replacement, UKA delivers long-term results of 10-15 years or more. The incision is smaller and the recovery time tends to be shorter than the full-fledge TKR.
Travis, PeerWell’s resident 29-year-old hip replacement recipient, suggests this to the younger crowd: “Have an honest conversation with your doctor about lifestyle goals. Be open to pursuing alternative treatment first, but know that a total hip or knee replacement isn’t the end of your active life.” In other words, be clear with your care team about what your end goal is; be realistic about the treatments available to you today and tomorrow; and know that most any action you take will improve your situation.
A final word of advice for the younger men and women dealing with chronic joint pain and osteoarthritis: think about the long-term when plotting your next move, do your research, and know that the discussed orthopedic procedures are among the most successful in modern medicine.