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Younger patients getting knees and hips replaced. Is this an additional burden on the healthcare system?

New research shows that patients undergoing total joint replacement are younger now than they were in 2000. According to a review from the National Inpatient Sample (NIS) database, the average patient undergoing a total hip replacement (THR) in 2014 was 64.9 years, while the average patient in 2000 was 66.3 years. In parallel, the average patient undergoing a total knee replacement (TKR) was 65.9 in 2014, and 68.0 in 2000.

Dr. Matthew Sloan, lead researcher and orthopaedic resident at the University of Pennsylvania in Philadelphia, tells Reuters Health by email: “These differences may not seem like much, but an average decrease of two years in a pool of 1 million people is a significant difference. It’s also a meaningful difference when you take into account the fact that these total joint replacements have a finite lifespan.”

Dr. Sloan further explains: “The technology for total hip and knee replacements continues to improve. However, at some point, the implant wears out. We believe modern implants without any unforeseen complications should last 20 years or more. The problem with an increasingly younger group of patients having these procedures, it becomes more likely that the implant will wear out during their lifetime. When this happens, a second surgery is required to revise the joint replacement. These procedures are not as successful as the initial surgeries, they are bigger operations, they take longer, and now the patient is 20 years older and not as strong as they were when they had the initial procedure.”

Because a second surgery is riskier and prone to complications like early failure or infection, the goal is to wait as long as possible so that a patient will undergo one surgery in their life. Other findings presented at the American Society of Orthopaedic Surgeon’s annual meeting include:

  • 55-62% of people who make up the majority of THR and TKR patients are women – this may be because women have a higher rate of arthritis compared to men
  • there are more men undergoing THR and TKR than there were in 2000
  • data from the US shows that there may be cultural or social differences among groups that cause non-Hispanic whites to pursue surgical treatments, while Asians seem to avoid surgery
  • in 2014, there were more than 370,000 THR and 680,000 TKR surgeries in the United States

Dr. Sloan and colleague Dr. Neil Sheth predicts that by 2030, primary THR is projected to reach 635,000 (171% increase) and primary TKR will reach 1.28 million (189% increase). Similar increases are expected for the second THR and TKR surgery. Dr. Sloan concluded: “These numbers are always changing. We will continue to look at new data as the numbers need to be constantly updated, especially if they are used to make predictions for future healthcare saving decisions, as the impact can be in the millions of dollars. It’s imperative to provide policy makers with high-quality data to inform decisions that will affect patient access to orthopaedic care and the financial viability of elective orthopaedic procedures.”

Tips on how to avoid knee or hip surgery

According to Harvard Health, “losing weight, strengthening muscles, and increasing flexibility may help you stave off joint replacement.”

Exercise and weight loss may help prevent the knee or hip pain and prevent surgery. When exercising, focus on the exercises that strengthen the muscles that support your joints – the quadriceps in the front of the thigh and the hamstrings in the back are key to knee strength. In an interview with Harvard Health, David Nolan, a physical therapist at Massachusetts General Hospital, said: “Every time you walk or run or do anything weight-bearing, the quads absorb the shock. The stronger your quads are, the less load that gets transferred into the joint.”

According to Harvard Health, the force you place on your joints can be up to six times your weight. It means that if you are 10 pounds overweight, it’s 30 to 60 pounds of pressure on every step. A dietician can help you determine the best meal plan for you – reducing your calories while ensuring you are getting what your body needs to build muscle and keep up your energy.

Exercises to build quad strength

  1. Lie down on your back, tighten your quads with your leg in front of you
  2. Lie down on your stomach, raise your foot into the air to strengthen your hamstrings
  3. standing-hamstring-curlsLeg curls – Hold the back of a sturdy chair with one or both hands to maintain balance, bend your right knee and lift your heel up toward your buttock, hold for 2-3 seconds, slowly lower it down, repeat and alternate between the right and left knee.


Exercises to build hip strength and flexibility

  1. Leg lifts – Clamshells the-clamshell
  2. Leg lifts – similar to the one in the previous section.
  3. Stretching before and after exercising will bring more blood flow to the area and makes the muscle more adaptable to change.