Health care costs by age

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Joint replacement technology attracts patients in their 50s, 60s

In the past, hip and knee joint replacement surgery – in which a damaged joint surface is removed and replaced with a metal or plastic implant – has been reserved mostly for the elderly. Patients under the age of 70 were not considered good candidates for the surgery because artificial joints tended to fail or wear out within 10 to 15 years, meaning many patients would require revision surgery.

However, recent advances in prosthetic joints now deliver longer lasting results, allowing people in their 50s and 60s to consider joint replacement, which can dramatically improve their quality of life.

The main reason for joint replacement surgery is injury or osteoarthritis, a degenerative joint disease in which the cartilage joint surface breaks down and ultimately wears out. The rubbing of bone-on-bone can cause significant pain, making any activity or even sleeping difficult. Younger people were traditionally given medication, steroid injections, and/or physical therapy, and denied surgery until they were older. This often left them with limited function and chronic pain. Today, if conservative treatments don’t provide relief, surgery for these patients is a viable option.

Surgeons and implant developers are continually finding ways to improve the prosthetics and surgical techniques to make this operation one of the most successful and effective treatments available in medicine today.

Hip replacement

Total hip replacement has become popular with younger arthritic patients who want to remain active. In a total hip replacement, the surgeon removes the entire head and neck of the femur (bony ball) and replaces it with a metal or ceramic ball on top of a long stem, which is anchored deeply inside the femur (thigh bone). The acetabulum (bony hip socket in the pelvic bone) is lined with a metal and plastic implant.

With hip resurfacing, instead of removing the entire head of the femur, the surgeon reshapes it and covers it with a metal cap on a small spike, which is then cemented on the bone. The socket of the pelvis also is then lined with a metal lined socket. Because so much of the femur is preserved, a patient can have total hip replacement later in life if the implant wears out. Resurfacing provides for greater range of motion and makes high-impact activities possible, although it does require a metal-on-metal bearing.

Other advances

▪ Innovative plastics and metals make the replacement joints more dependable, durable and long-lasting.

▪ New metal attachment surfaces have enhanced the adjacent bone’s ability to grow into the implants, forming a lasting and secure bond that will last for decades.

▪ Improved implant designs give patients a better function.

▪ The newer types of plastic greatly reduce wear and wear particles, preserving the supporting bone. This virtually eliminates osteolysis – an autoimmune reaction that causes softening and reabsorption of the bone around the implant, destroying its mechanical function.

▪ Newer, less-invasive techniques make for a less-painful surgery and more-rapid recovery.

Before deciding if joint replacement is right for you, consider the benefits and risks.

Pros

▪ Significant improvements in pain and function resulting in improved quality of life.

▪ Success rates that exceed 95 percent – even at 10 years.

▪ New techniques preserve more bone, allowing for future revision surgery if necessary.

Cons

▪ Joint implant components can loosen or wear out over time, and younger patients may require a revision surgery to repair the implant. The failed prosthesis often causes bone loss, making it challenging to attach the new implant. Patients who have metal-on-metal hip resurfacing have higher rates of revision surgeries.

▪ Dislocation of the new joint, requiring treatment.

▪ Possible complications of surgery – blood clots, infection, implant loosening, fractures, nerve or blood damage and joint stiffness.

As long as patients are healthy enough to withstand the rigors of surgery, they can be offered an opportunity for improved quality of life with a joint replacement. If you’re considering joint replacement surgery, get the facts. Then talk in detail with a skilled surgeon who can guide you in your decision process.

John R. Schurman II is an orthopedic surgeon and the medical director of Via Christi Joint Replacement Center. Read more here:

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