Younger Patients Seeking Joint Replacement


Special Contributor

The Dallas Morning News
September 12, 2010

Joint replacement was once the surgery of last resort for elderly folks who’d otherwise end up bedridden.

Not anymore.

For Diane Hitchcock, 56, of Noank, Conn., knee replacement surgery meant she could go rock climbing again, just six months after the surgery.

Richard Rosebrock, 56, of Sanger, expects that hip replacement surgery will allow him to return to his job as a Carrollton firefighter — lugging up to 60 lbs. of gear.

“It’s not unusual for a 50-year-old to get joint replacement surgery these days,” says Dr. Clinton Bell, an orthopedic surgeon and sports medicine specialist with Methodist Health System in Dallas. “Fifteen years ago, that was not the norm at all.”

“Patients have more options and are choosing to have the surgery sooner, rather than later,” says Dr. Geoffrey Westrich, Hitchcock’s orthopedic surgeon and director of joint replacement research at the Hospital for Special Surgery in New York.

Projections show that by 2011, more than 50 percent of patients requiring hip replacements will be younger than 65. Same thing for knee replacement patients by 2016. Among knee-replacement patients ages 45-54, the number of procedures is projected to grow from less than 60,000 in 2006 to almost a million by 2030.

Demand is increasing so quickly that one study, presented to the American Academy of Orthopaedic Surgeons’ annual meeting in 2009, predicted a shortage of surgeons to perform the procedures.

To help handle the growing number of surgeries, Methodist Health System’s Dallas campus offers a daylong “Joint Academy” every Tuesday. (The hospital performs more than 250 joint replacements annually, up more than 50 percent from 2007.) With one visit, patients can take care of pre-op tests and find out everything they need to know, ranging from where to park on the day of surgery to how to navigate airport metal detectors afterward.

Younger patients tend to ask more questions and want more information, according to Jennifer Tullis, a registered nurse and the Joint Academy’s coordinator.

“With a joint replacement, the outcome is based about 50 percent on what the doctor does and 50 percent on what the patient does,” she says. “If a patient knows what to expect and takes control, they’re likely to get better results.”

So what’s behind the increased demand from younger patients? Experts point to two opposing factors — exercise and obesity.

Baby Boomers grew up expecting to continue strenuous activity well into mid-life and later, and some have joint injuries to show for it.

And as obesity rates soar, excess weight puts more stress on the joints, leading to increased risk of osteoarthritis and injury.

In either case, joint replacement doesn’t offer a quick fix. Athletes can resume activities they’ve done before surgery, but high-impact exercise, such as running, is verboten. And surgeons counsel overweight patients to lose weight, because they run a higher risk of complications, and excess pounds will wear out an implanted joint just as they did the original. Surgery to repair an implanted joint can be problematic.

Still, younger patients who accept these caveats will benefit from surgical advances achieved in recent years.

“Joint replacement is still a tough surgery, but the recovery is much quicker now,” said Jill Bass, director of rehabilitation and orthopedic services for Baylor Regional Medical Center at Plano. “Most people only stay in the hospital two or three days and don’t need protracted rehab.”

Rosebrock, whose hip replacement was performed on June 10 at Baylor Plano, was out of bed and walking, with a walker, the next day.

“There was a time when we’d advise people to wait till age 65 or 70 to have the surgery,” says Bell. But thanks to improvements in materials, implant design and surgical techniques, he says, “we’re more confident about recommending the procedure at an earlier age.”

Mary Jacobs is a Dallas freelance writer.