By Carroll Walton, Novant Health Healthy Headlines
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Joint replacement surgery isn’t just for the elderly anymore. The patients across the country undergoing knee and hip replacements are trending younger. According to a national study by the American Academy of Orthopaedic Surgeons, the average age of hip replacement patients has ticked down from over 66 to slightly under 65. And knee replacement patients average age 66, down from 68.
Dr. Steve Martin of Novant Health Orthopedics & Sports Medicine – Ballantyne estimates that half of the patients he performs knee replacements on are under 60.
“I think the mindset for patients is a lot different than it might have been 20 years ago,” said Martin, who has spent seven years in Charlotte, arriving from a previous practice in Albemarle. “I think surgery has become a much more acceptable thing for people.”
One reason for that is that patients are a lot more active – and want to stay that way.
“They’re expecting to play tennis well into their 80s now, especially where my practice is in Ballantyne,” Martin said. “The 70-year-olds think it’s ridiculous that they can’t go play golf five days a week. They’re just not willing to accept limitations.”
The need for surgery at younger ages has also increased with rising levels of obesity and diabetes in the United States. Sedentary overweight patients are more likely to put extra stress on their joints, which leads to cartilage damage and ultimately what doctors refer to as degenerative joint disease.
The American Academy of Orthopaedic Surgery recommends that patients with degenerative joint disease of the knee reduce their body mass index to 25, and if they still have pain to have surgery. Those with a body mass index between 25 and 30 are considered overweight, 30 and higher obese. You can calculate your BMI here.
Sometimes, surgery is ultimately unnecessary once the weight comes off. But that’s a difficult conversation to have at times. Martin said the issue can come up several times a day because some patients would rather undergo surgery immediately rather than lose weight first.
“It is a hard sell,” said Martin, who added that he agrees to treatment plans on a case-by-case basis.
If weight loss doesn’t work, doctors often recommend other more conservative treatments like physical therapy and/or using pain-management techniques like injections or nerve blocks.
Just as much of a factor as patients wanting joint replacement surgery younger, Martin said, is doctors’ willingness to perform it sooner.
“It’s an industry change,” Martin said. “The orthopedic surgeon used to look at a 50-year-old patient say, ‘Well, you need a knee replacement, but you’re too young. So come back and see me in 10 years.’ And we don’t do that anymore.”
“Our implants are better, our outcomes are a little better,” Martin said. “Twenty years ago, the expectation was to get 10, 12, maybe 15 years out of a knee replacement. In the ’90s, we had some bad polyethylene (one material used in surgical implants) because of sterilization techniques. We don’t have that problem anymore. Longevity of the replacements is much better than it used to be. I think that’s what’s led most of us, really everybody, now to offer joint replacement surgery to someone much younger.”
Martin said the technology he’s using to perform knee replacement operations is improving his outcomes as well. For the past year he’s been operating with a computer navigation system. Now he can insert markers on the bones surrounding the knee that serve as a GPS system of sorts that gives him a more accurate measure of the angles and cut depths when performing knee replacement surgery. He uses the CORI system by Smith+Nephew.
“(At first) I did not want to do the computer navigated knee, I thought it was ridiculous,” Martin said. “In the first 20 cases I was ready to throw the equipment out of the window. And then I started to really incorporate all of the information that it was giving me and understand what I could do with it. And I went from not really wanting to do another knee replacement to being excited about the next knee replacement because patients are coming back happier from surgery. The X-rays are spot-on every time. I have the components exactly where I wanted them to be. It’s just become a different experience.”
As the surgery techniques and outcomes improve, so do recovery times. Most patients of knee replacement surgery – generally the more complex of hip and knee procedures – can walk within a few hours of their operation. And while patients used to stay in the hospital for a week or two after surgery, now they’re being released the same day in most cases.