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Leading Medicine Magazine, Vol 7, No 1 - 2013

A total joint replacement patient was once an older individual, suffering severe pain from arthritis and in search of solutions that could return them to comfort and a level of moderate function. Opting for this surgery late in life tended to reduce the likelihood of having to perform a repair or a second replacement. But in recent years, the number of younger patients choosing to have total joint replacement has sharply increased. Hip replacement statistics from the American Academy of Orthopedic Surgeons provide a representative example: in 1998, patients aged 45 to 64 made up just 27 percent of the total number of hip replacements performed. But by 2008, this number had risen to 40 percent. Orthopedic surgeons at Methodist have seen this shift fi rsthand. There are several reasons why. DIFFERENT LIFE EXPECTATIONS One factor is that today’s younger joint replacement patients are simply more active than those of years past — and they’re less likely to be satisfi ed with a lifestyle of signifi cantly reduced physical ability. Faced with signifi cant pain from a damaged or deteriorated joint, many of these younger, active patients are actively investigating joint replacement as an option — seeing it as a way to continue with the physical activities that are an important part of their lifestyles. “I’ll see people, and their entire social network is around tennis,” says Dr. Kenneth B. Mathis, an orthopedic surgeon at The Methodist Hospital and associate professor of clinical orthopedic surgery at Weill Cornell Medical College. “It’s what gives them pleasure in life. And if it’s really important to them, isn’t that why we’re doing the joint replacement? Number one is to get rid of pain, but also to improve their quality of life.” Debby Dreyfus, 53, is a good example of a patient whose experience with joint replacement happened much earlier than expected. X-rays taken after a car accident revealed that her hip was degenerating. For more than a decade after this diagnosis, she continued her highly athletic lifestyle, including specifi c exercises designed to strengthen supporting muscles around her hip. It worked for a time. “The symptoms would come and go,” explains Dreyfus. “I was always working out at some level, and changing my workout as my pain increased over time.” Eventually, however, the pain of the deteriorating joint became a signifi cant problem. “I would go to the gym and work out in the morning,” she says. “Then what I could do, over time, was come home and be a couch potato — I was basically not very mobile for the rest of the day. And I’m a very active person. When you basically can’t walk short distances because it becomes too painful, then it’s defi nitely time to make a change.” The change was a total replacement of Dreyfus’s hip joint performed by Mathis, a team physician for Rodeo Houston. MORE WEAR AND TEAR The original damage to Dreyfus’s hip was most likely the result of an injury during childhood. Many other younger patients are presenting with cumulative damage from a lifetime of sports and exercise. “People are wearing out their joints more quickly,” says Dr. Stephen Incavo, professor of clinical orthopedic surgery at Weill Cornell Medical College and section chief of adult reconstructive surgery at the Methodist Center for Orthopedic Surgery. “People are generally much more active, and high school and college sports have become much more prominent than they were one or two generations ago — especially for women.” Overuse injuries from running and racquet sports; arthritis secondary to past surgical repairs to ligaments in the knee; and complications from incomplete healing of old injuries on the playing fi eld or the ski slopes are all leading relatively young patients to discuss joint replacement options with their surgeons. Houston Texans defensive line coach Bill Kollar, now 60, played professional football with the Cincinnati Bengals and the Tampa Bay Buccaneers for eight seasons — until a knee injury ended his playing career. “Back when I was playing, I injured it, tore the ACL (anterior cruciate ligament),” says Kollar. “They didn’t repair the ACL — I was done playing. So they decided to just let it go, try to strengthen it up. And I’d already had cartilage that was taken out,” says Kollar. Injuries like these have lasting effects. “If you injure your ACL, or tear your meniscus or another knee ligament when you’re young, that at some level is the beginning of damage to your knee joint,” says Incavo. “Although it may take many, many years to develop, it really predisposes you to have arthritis of your knee later in life. The same goes if you have a fracture of bones around the joint.” Over time, Kollar’s injured knee began to have a negative impact on his comfort and his physical activities. “My knee just kept getting worse — it was down to bone-on-bone,” Kollar says. “They said, ‘sooner or later you’re going to end up getting a replacement,’ because it was bothering me quite a bit.” After he moved to Houston, Kollar fi nally elected to have the knee replaced. Leading Medicine • Volume 7, Number 1 3 7


Leading Medicine Magazine, Vol 7, No 1 - 2013
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