Musculoskeletal Report—August 12, 2009
Despite the common stereotype about hip replacement surgery patients, there is no “right age” to get one – there are a variety of factors that necessitate them, and it is not necessarily because of age. Today’s hip replacement patients are young, active and motivated – and they are seeking hip replacements at higher rates than ever before.
Growing numbers of orthopedic surgeons are seeing and operating on patients like Don Philpott as they realize that you are never too young or too old to undergo total hip arthroplasty.
“I am seeing more and more young patients that have pain and have seen multiple doctors who have said ‘you are too young for surgery,’ but they are in their 40s or 50s and are miserable,” said David Mayman, MD, an assistant attending orthopedic surgeon and the clinical co-director of the Computer Assisted Surgery Center at Hospital for Special Surgery in New York. Mayman is also Philpott’s surgeon.
“The oldest patient I have done was 102 and the youngest was a girl in her teens,” Dr. Mayman said.
Why the paradigm shift? “Implants are lasting longer and longer and these younger patients do really well,” he said.
“About 90% of standard bearing materials last 20 years or longer, and 80% last 30 years or longer,” Mayman said. “Ceramic and metal-on-metal implant wear rates are lower so they could last even longer,” he says. In fact, “there is no reason to think they will fail ever,” he said. “If we have an honest open conversation with younger patients and they know they may need a revision in the future, it is reasonable to do joint replacement.”
It’s more than reasonable if you ask Don Philpott. He underwent hip replacement surgery on his left hip due to severe arthritis, and he was up and ready to get back to his life shortly afterward the surgery.
“I feel great,” Philpott said. “I am hoping to go back to some jobs in mid-August and I have plans to start teaching again at the end of August.”
Philpott's advice to others? “If you are a candidate, don’t put it off.”
Orthopedic surgeons can even tailor the surgery to the needs of a specific patient by choosing specific implant materials and designs, Dr. Mayman said. For example, “one of [Philpott’s] concerns was that he may dislocate his hip, so we did a metal on metal implant with a large femoral head to eliminate risk of dislocation,” he explained.
“We can look patient to patient and decide what is best,” Mayman said. “An 80-year-old may get a standard hip replacement because it is proven and will last for the rest of her life, but in a 40-year-old we may be willing to use something that has a potential to be better and longer-lasting.”