Hip and Knee Replacement: It’s Not Your Grandfather’s Surgery

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When you think of the typical patient having a hip or knee replacement, do you see a 75-year-old with limited mobility, perhaps needing the assistance of a walker or cane? Well, it’s time to change your perception. Today, more and more people in their 40s, 50s, and 60s are getting their hips and knees replaced.

“Historically, there was a reluctance on the part of surgeons to perform this procedure in younger people because they were worried about what will happen 10, 20, or 30 years down the road,” says Jacob Drew, MD, joint replacement surgeon in the Carl J. Shapiro Department of Orthopaedics at Beth Israel Deaconess Medical Center.

The biggest change in that mindset has been the development of more advanced materials being used for joint replacement devices. These new plastics, ceramics, and metal alloys have lengthened the lifespan of joint replacement. “Fifteen years ago, a hip or knee replacement would last 10 to 15 years,” says Dr. Drew. “Now, we anticipate them lasting closer to 25 or even 30 years.”

For people who may need more than one joint replacement in their lifetime, it’s encouraging to know that the technology for revision surgery (when a doctor removes some or all of the parts of the original prosthesis and replaces them with new ones) has also advanced. “For patients who need a ‘redo’ procedure, it’s not as daunting as it may once have been,” says Dr. Drew.

Arthritis, a condition most commonly found in older adults, is the main cause of joints wearing down over time. However, in younger people, arthritis can occur after an injury. Additionally, other conditions, such as osteonecrosis (collapse of the bone due to low blood flow to the bone cells) or hip conditions developed early (including Perthes disease – a problem of blood supply to the hip – or dysplasia – a problem where the socket does not form properly as a fetus and in early childhood) can bring about the need for a joint replacement procedure in younger patients.

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People who regularly exercise and stay active might wonder if there is anything they can do to help prevent their joints from wear and tear over time. According to Dr. Drew, there is no way to prevent arthritis, although there are certainly steps individuals can take to reduce their risk and slow the progression of joint deterioration. Maintaining a healthy body weight, using proper body mechanics when exercising, and stretching can all sustain joint health. People are encouraged to participate in sports and activities they enjoy, though low-impact exercise, such as swimming, biking, or the elliptical may be easier on the joints than high impact activity such as running on pavement or basketball.

“Often, arthritis doesn’t discriminate, but there are ways to deal with its symptoms,” says Dr. Drew. “In large part, it’s driven by a combo of genetics and circumstance, like an old injury or people who have led hard lifestyles, like performing manual labor for many years.”

The good news at the Arthritis Center at BIDMC is that non-surgical treatments are usually recommended first. “Typically everyone with an arthritic knee deserves non-surgical therapy first – physical therapy, bracing, medication, injections, or mind-body interventions like Reiki and massage,” says Dr. Drew. “Surgery for a patient of any age is the last resort.”

Even better, the total time procedure time for either a hip or knee replacement is only about 90 minutes, and typically includes a one-night stay in the hospital. Dr. Drew says that some “really motivated” patients can even go home safely the same day.

“We know that, especially with younger patients, they really strive to get back to their active lives quickly,” says Dr. Drew. “These are often very healthy people who just happen to have a bad joint. We emphasize a positive message of wellness, rehab, and the right amount of pain control. We’re focused on getting patients back to their normal routines as quickly and safely as possible.”

For more information on hip and knee replacement surgery, visit bidmc.org

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