Hip and Knee Replacement - No Longer Your Grandfather's Surgery

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, 30 years down the road,” said Jacob Drew, MD, joint replacement surgeon in the Carl J. Shapiro Department of Orthopaedics at Beth Israel Deaconess Medical Center.

Drew said 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 life span of joint replacement. “Fifteen years ago, a hip or knee replacement would last 10-15 years,” said 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,” said 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), can bring about the need for a joint replacement procedure in younger patients.

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 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, Drew added.

“Often, arthritis doesn’t discriminate, but there are ways to deal with its symptoms,” said 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” said Dr. Drew. “Surgery for a patient of any age is the last resort.”

And even better news for patients who do need surgery is that the total time of the procedure is only about 1 ½ hours for either a hip or knee replacement, and typically includes a one-night stay in the hospital. Dr. Drew said 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,” said Dr. Drew. “These are often very healthy people who just happen to have a bad joint.  We emphasize that positive message of wellness and through rehab and the right amounts of pain control, we’re focused on getting patients back to their normal routines as quickly and safely as possible.”