Am I too young to undergo total knee arthroplasty?

Posted on: October 14th, 2014 by Dr. Frank Bohnenkamp

Many younger patients with debilitating knee pain and a diagnosis of end stage arthritis of the knee are under the impression that getting a knee replacement is only for elderly patients. Unfortunately, this leads to many patients under the age of fifty living in pain because they are scared to consider joint reconstruction.

And that makes sense, doesn’t it? After all, those patients are considering replacing a part of their body, and for some reason, there’s a mentality that you have to be elderly to have that done.

My hope is that this post can alleviate some of that concern and help people–maybe you–to understand that total knee arthroplasty is a perfectly good option for those with end-stage arthritis because it can give you your life back by getting rid of the pain.

Different diagnoses can result in early end-stage arthritis:

  • Untreated rheumatoid or inflammatory arthritis or gout
  • Post-traumatic arthritis from treated complex fractures about the knee
  • Avascular necrosis and collapse of the bone.

Young patients with severely painful knees and severe arthritis tend to do poorly as they age. Here’s what I mean by that.

  • You are less productive at work.
  • You tend to be less physically healthy because you cannot exercise or even mobilize.
  • Lack of exercise and mobilization can result in other medical problems such as heart disease and diabetes which can shorten your lifespan.
  • Daily knee pain can also affect not only personal health, but put a strain on family, co-workers and friends. This tends to lead to other situations such as depression, anxiety or marital problems.

For many people, they would rather try to deal with the pain than consider total knee arthroplasty as a treatment option, which makes sense, right? We all self treat. We say things like “I’ll just back off for a bit and take it easy” or “I used to exercise, but my knees hurt too much, so now I don’t.” And we hope that everything just sorts itself out, but end-stage arthritis won’t do that.

Interestingly, you are putting off what you think is a bad procedure because of your age, when in fact it may dramatically improve not only your emotional and physical health but significantly improve your quality of life.

I think many people–even some health care professionals–feel like a “mechanical knee” is a salvage operation which should only be done as a last resort if all else fails. This gives the impression that total knee arthroplasty will not perform as well if done in a younger patient.

Advances in tech are changing our perceptions

The truth is, however, that there have been many advances over the past few decades to optimize implant design and function. Total knee replacements last longer and longer because of a better understanding of new biomaterial and biomechanical designs.

According to a review article in 2008 by Meneghini and Hanssen et. Al, cement-less designs seem to be an excellent option which ultimately allow the patient’s own bone to grow and incorporate into the implant because of newer and stronger porous metals. This prevents future problems seen before with standard cemented designs such as loosening or collapse of the implant!

Other problems we used to see in the past with first generation designs are also much less seen today, partially due to specialized ceramic coatings and stronger plastic, resulting in less implant wear. According to a review article and meta-analysis by Mont et al published in Journal of Knee Surgery 2014, short and long-term outcomes on over 3500 total knees showed cement-less total knees had comparable survival to the gold standard cemented total knee 10 and 20 years out.

Another option in some patients for a more natural feeling knee is a partial knee arthroplasty to replace only a portion of the pain-generating site–assuming the arthritis is isolated to only a portion of the knee.

Not only have implants improved over the years, but surgeons today are well trained in the art of performing total knee arthroplasty. We are faster, less invasive and vigilant about inserting a well-balanced implant resulting in more natural function and range of motion.

Replacements don’t slow you down.

In general, patients are able to get back to work and high level recreational activities much quicker than before. If you are young, have debilitating end-stage arthritis, and all conservative options have failed, you may be a candidate for an arthroplasty procedure.

It’s time for us to remove the stigma of joint replacement and to realize that we should all be considering what we can do it improve our quality of life. For some patients, conservative treatments can accomplish their goals. For others, an arthroplasty procedure is the appropriate gateway to a happier, healthier life.

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