Hip and Knee Replacement Patients are Getting Younger
As joint replacement surgery has evolved, so have the patients. Namely, the average age of those having hip or knee replacement surgery is decreasing. For hips, the average age is now 65 and knees is 66.
According to a study from the American Academy of Orthopedic surgeons, not only is the average age of joint replacement patients younger, but there is also a projected increase in the number of surgeries that will be performed before the end of the decade.
What was once thought of as a last resort for older patients has now transitioned to a way for active individuals with arthritis to continue their healthy lifestyle well into the future.
Non-surgical options for hip and knee arthritis
It is best practice to offer patients nonoperative treatments first. That includes activity modification, gait aides, nonsteroidal medications, and injections, among others. It is only when these treatments fail that I offer joint replacement surgery as an option. The goal of that surgery is to relieve pain and improve joint function for our patients.
New joint replacement technologies and techniques to benefit younger patients
Everyone’s bones are a little bit different. There are several new approaches to performing joint replacement surgery, with a focus on less invasive procedures. I work to customize each surgery to the individual patient.
- Direct anterior approach for hip replacement. My approach to hip replacement has been molded through special fellowship training in both young adult hip surgery and the direct anterior approach (DAA). I’ve been performing hip replacements through this approach for over 10 years now, with experience performing thousands of surgeries. The DAA and other minimally invasive approaches may be of particular benefit in the younger active patient. These procedures allow surgeons to work through natural soft tissue planes without cutting muscles or tendons. This helps to prevent damage to the well-functioning anatomy of patients. The DAA is a more technically complex surgery and can take longer in the operating room, but results in a quicker recovery and less risk of hip dislocation. While other approaches to minimally invasive surgery can have excellent results, I have found the DAA works best.
- Image-guided surgery. Some hip surgeons, including myself, use a technology known as “fluoroscopic image guidance” during surgery. This image guidance offers the surgeon greater quality control to align the implant, so it fits more precisely to a patient’s unique anatomy. Precision in placing implants allows me to forgo any hip precautions, so my hip patients do not have to worry about not crossing their legs or elevated toilet seats to prevent hip dislocation.
- Cementless technology for hip and knee replacements. The implants we use are complex biomedical engineering devices. Bone cement, or a type of grout, was originally used to keep implants in place during joint replacement surgery. Unfortunately, that bond can break down over time. Years ago, “cementless technology” was developed for hip replacements and has now become the standard of care. Development of uncemented total knee replacements took more time to perfect, but new technologies such as 3-D printing of titanium and the development of porous tantalum have revolutionized uncemented knee replacement designs. The potential benefit of cementless fixation is a longer-lasting, more durable bond between implants and our patient’s bone. We have seen excellent results with certain uncemented designs, and my partners and I are now using some of these implants in appropriate patients, most commonly younger patients where long-term fixation will be of greatest benefit.
Do younger joint replacement patients have shorter hospital stays?
It’s important to note that most of our patients still spend the night in the hospital and leave the next day. Younger, healthy patients can have shorter hospital stays after hip or knee replacements. In fact, in some instances, younger healthy patients with good home support can even leave from the recovery room and go home on the day of surgery.
My partners and I were the first in Rhode Island to offer outpatient total joint surgery, without the need for an overnight hospital stay. This accelerated surgical recovery program has increased in popularity, especially through the COVID-19 pandemic. I believe there is a healing value for patients recovering in their own home. They can sleep in their own bed, eat their own meals, and heal in the comfort of their normal environment, with their loved ones to support them. There is also value in the resources available in the hospital for our patients with medical conditions that may need treatment during their early recovery.
Is it possible to replace only part of a hip or knee?
Everyone develops arthritis differently and I treat each patient as an individual. In some patients, more often in my younger patients, only one part of their knee becomes worn out. For these patients, targeted surgery to replace only the worn-out part can be very helpful. In general, however, it is much more common for patients to have a total knee replacement. Often there is arthritis in more than one part of the knee. Replacing only part of the knee will not treat all the arthritic areas in these patients. Partial hip replacements are also useful, but usually for patients who come to the hospital with a hip fracture. We have found partial hip replacements are not very beneficial in younger patients.
Are hip and knee joint replacements major surgeries?
Yes. It is important to understand that although joint replacement surgeries are some of the safest surgical procedures, no surgery has a 100 percent success rate and there are risks to any surgery, though complications are rare.
Some patients are also at higher risk for complication due to their unique situation and medical conditions. We do our absolute best to work with those few patients who have complications to bring them to a successful outcome.
While the surgery is not without risk, many patients with severe hip and knee arthritis can experience significant benefits from joint replacement. My best advice is for patients to sit down with their surgeon before considering hip or knee replacement, ask questions, and have a conversation about what the risks and benefits are. Then you can make an informed decision about whether now is the right time for you to pursue surgery.
How has joint replacement surgery changed?
Change is a constant in orthopedic surgery. It keeps the job interesting! I put a lot of thought into using new techniques and technologies in the treatments I offer. Before changing something that has worked well in my hands, or offering patients something new, it is critical to study and evaluate these new techniques and technologies to understand risk and potential benefit to patients.
I do, however, believe it is our responsibility to evaluate and offer new treatments and try new things because it is in the best interest of patients to practice at the state of the art. If we get stuck doing the same thing over and over again, we will never improve, we will never move medicine forward.
What is the failure rate of joint replacements?
With the bearing surfaces and replacements currently available, as a rule of thumb, there is about a one percent all-cause failure rate per year after joint replacement surgeries. That would mean that for a 60-year-old there is an 80 percent chance they will still have a well-functioning joint replacement when they reach age 80. Those are good odds in the patient’s favor.
For younger patients, the failure rate I discussed does not perfectly apply. Any mechanical device will wear out over time and service. Younger patients are more likely to live a higher-impact lifestyle, putting more stress on their implants. This may lead to a shorter effective lifetime before revision surgery is necessary.
This is really an arena where newer technology and techniques have great potential in improving the longevity and durability of the replacement surgeries we perform for these younger individuals. This is also where my background in engineering has given me a unique approach to understanding and evaluating the intricacies of new technologies and their application to updating the mechanical and biologic aspects of these complex engineered devices.
How do you approach using these new technologies and changing the way you do surgery?
As an engineer, I am attracted to new technologies, but as a surgeon I am cautious of unproven treatments. This has really helped provide a balance to my practice. I continue to adapt and update the techniques and technology in my surgical operations, but only after careful consideration of the effect on patients as human beings.
The field of orthopedics and adult reconstruction of the hip and knee is really the perfect combination of engineering and medicine. For me, the ability to use technology to find and perform a surgical solution to fix an anatomic problem, and then to share in a patient’s transformation from pain and disability to function and ability is what inspires and drives me every day.
If you are considering hip or knee replacement for your joint pain, learn more about us and how we can help you on our website.
About the Author:
Derek R. Jenkins, MD
Derek Jenkins, MD, is an orthopedic surgeon with the Lifespan Orthopedics Institute and assistant professor at The Warren Alpert Medical School of Brown University. He specializes in adult reconstruction of the hip and knee, with a special interest in direct anterior total hip replacement, gap balanced total knee replacement, partial knee replacement and revision of failed/ infected joint replacements.
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