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Jonathan Cluett, M.D.

Young Patients Want New Knees

By May 11, 2011

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The Wall Street Journal published a review of trends with knee replacement surgery. A procedure that used to be reserved for elderly, more sedentary individuals, joint replacements are being performed on younger, more active patients.

Doctors typically recommend patients avoid high impact activity after joint replacement including running, soccer, and basketball. Even playing golf is controversial when trying to maximize the longevity of a knee replacement implant. However, many patients want to maintain their active lifestyle, and are unwilling to give up their favorite activities.

This is a complicated problem, because if a joint replacement does wear out, the second replacement, called a revision joint replacement is a more difficult and more expensive surgery. Complication rates are higher after revision replacement, and the results of surgery are less predictable.

Should patients be able to do whatever they choose after joint replacement? Should doctors be performing this surgery in young patients who want to do sports? Most people agree that patients who can't walk, climb stairs, or sleep comfortably, should be eligible for joint replacement, but what about middle-aged athletes that can't run marathons? It's a difficult question! Please leave your comments!

Related: Knee Replacement in Young Patients | When is it Time for Replacement? | Sports After Knee Replacement

Source: "Pushing Limits of New Knees" Wall Street Journal. April 19, 2011.

Image Medical Mulitmedia Group

Comments
May 17, 2011 at 9:02 am
(1) Marie Shanahan says:

I am the Founder of the ON AVN Support Group Int’l Association, Inc., which is a support system for all those who suffer from Osteonecrosis/Avascular necrosis. We are seeing a tremendous increase in younger patients with this destructive bone ailment, an increase probably due in part to more accurate diagnosing. Be that as it may, our younger members face the challenge of a knee or knees, and in too many cases multiple other joints, that are so destroyed by ON/AVN that the joints are useless and cause them incredible chronic pain. Many of their doctors/surgeons try to explain about the complications of too-early replacements, but these unfortunate people are living lives with poor quality of living due to the pain and immobility. it is heart-breaking to see so many youngsters living with such pain and unable to walk, when a replacement might alleviate their immediate medical problem for quite a few years. Talk to them and they will TELL you that they opt for a new joint(s) and would obey the ‘rules’ and take as good care of their new joint/s as possible. However, would they really be able to follow through with their promises? It is so difficult to be young and to be so terribly physically challenged, while living in such awful pain! I wish there was some type of answer for them that would be of real value and help.

Just as a side-note, far too many of our younger patients are cancer survivors and developed ON/AVN as a side-effect of chemo and corticsteroid. and/or radiation treatments. This is so very unfortunate! To have beaten such a serious illness as cancer, only to wind up crippled is most sad.

May 17, 2011 at 11:15 am
(2) Gigi Morris says:

Hi, I am a 65 year old registered nurse who is ten weeks post partial knee replacement. Prior to having surgery I tried physical therapy and sinvisc injections. I could only walk very short distances with the use of a cane and the pain was unbearable. All I did was sit around being inactive and gaining weight. The physical therapy prior to surgery was very helpful but the injections did not work for me. I am now active (mainly walking and using a recumbent bike and taking part in a water fitness class). I am very pleased with the outcome of my surgery. I no longer use a cane to ambulate. There are a few things I would like to advise prior to surgery: 1. Choose your surgeon very carefully. My orthopedic surgeon specializes in knee replacement. After surgery I was on a special unit that only cared for joint replacement patients. So the nursing staff was excellent in knowing how to care for me.
2. LOSE WEIGHT! I had gained many pounds because I could not walk without pain. So I sat around ALOT! Since the surgery I have lost several pounds. THERE ARE LOTS OF BOOKS/ARTICLES OUT THERE ON HOW TO TRIM PORTION SIZES AND EAT HEALTHY. NO EXCUSE NOT TO GET IN BETTER SHAPE.
3. Postoperatively, perform all the exercises that you are given by your physical therapist. You must keep up with your physical therapy so you will have good extension and flexion of your knee.

Good luck and don’t be afraid of the surgery. You will be so happy afterward. I can walk and play with my grandkids. I do have minor aches but as I progress with exercising and staying fit they are not an issue at all.

May 17, 2011 at 12:15 pm
(3) Thomas Taranto says:

I am a 48 year old man. I am trying to decide on knee replacement surgery. My knee is keeping me from doing activities such as walking with out pain. My sergon just gave me the 3 synvisc injections which doesn’t seem to help. After my x-ray they told me I had a knee of an 80 year old man. They also say I am to young for the surgery. My quality of life is not very good at this time. I can’t really do my job anymore which was working on my hands and knees climbing ladders,standing on ladders and doing a lot of crawling. (Telecom Installation). I do have appointment with my Doctor in June to discuss my next options. Right now my i am very inactive. I hope they decide to do it so I can get back in the game of life. Right now I feel like a slow turtle trying to keep up with the rest of the world.

May 17, 2011 at 1:47 pm
(4) Susan Aldridge says:

I would counsel anyone to explore every option out there, but when it comes down to giving you back quality of life and being able to live and work, I heartily recommend knee replacement surgery. After many years of heavy physical labor, I had my first total knee replacement in 2009. Rehab went extremely well and I was back on the job fully functional in 17 weeks.

I am now 6 weeks post-operative with a total knee replacement on my other knee. I can’t begin to describe how wonderful it is to walk like a normal person, pain and limp-free. I don’t have to sit watching with envy as people walk so easily and freely–I can too! I fully intend to guard both knees and follow all the “rules”, and to this end, I am now losing weight with all the increased activity. My surgeon is an angel who has given me back not just quality of life, but a life. By the way, I’m 51.

May 17, 2011 at 4:38 pm
(5) Sandy says:

My brother had a knee replacement in his early 60′s and was able to return to his tennis (doubles only) and enjoy the rest of his life before he died of PC at 71!

May 18, 2011 at 9:10 am
(6) JaNell says:

I am 35 years old and have had both of my knees replaced. I am so glad I had the surgery. I can know walk with out pain and it is wonderful.

May 18, 2011 at 9:23 am
(7) P. McCormack says:

My 19 year old daughter will likely get bi-lateral knee replacements later this year. Yes, she is 19. She has suffered from AVN (Avascular Necrosis/Osteonecrosis) in her hips (now stable) and knees for the last 4 years. After 3 bi-lateral core decompressions, and years taking narcotic pain medications, she has had it. She had to drop out of community college, and can only work about 8 hours a week at a PT job. Her AVN was caused by taking steroids and chemo for other medical conditions.

She is looking forward to getting her life back on track, she has beaten so many serious medical challenges in the last 4 years. I am grateful as a Mom that doctors are becoming more willing to do this surgery on younger patients. We understand this is a drastic decision, of course, and have considered it carefully before concluding it is the best option.

May 19, 2011 at 7:02 pm
(8) Colleen says:

Being only 35 and facing a total knee replacement sounds crazy to most, but if anyone had to live day in and day out with the severe pain from avascular necrosis like I am dealing with now, they would not think a TKR sounds crazy at all. Like a lot of other people that have avascular necrosis, mine was caused by steriods. I have been dealing with the avn pain for almost four years now and have tried conservative treatments consisting of reduced weight bearing with crutches, several core decompressions, losing weight that was put on thanks to the steriods and pain mamangement. The pain on a good day is at min. a 8 out of 10 with pain medicines. On a bad day the pain is a 12 out of 10. I feel that since I have tried conservative treatments and still no relief in the left knee that a TKR at 35 is justifiable for me and my orthopedic surgeon also feels the same way. Is a knee replacement something I would ever have expected at age 35, no but I also never expected to be on all the steriods I was on that caused the avn in the first place. About four years ago when I was first diagnosed with avn, my orthopedic surgeon explained to me that he wanted to try conservative treatments first before we even discussed joint replacement. I agreed with him and felt that it was the right thing to do. If my doctor four years ago told me my only treatment option was a replacement, I’m sure I woud feel differently about things. Each case and reason why a younger person needs a joint replacement needs to be loooked at on an individual basis. If debilitating pain is taking over a younger persons life due to a diseased or warn out joint and if conservative treatments have not helped then it is time to explore how a joint replacement could help the person and help improve their quality of life. Yes, I know that I will need revisions and possibly a replacement of the TKR down the road, but to me getting 15 or more years of pain relief sounds wonderful.

June 13, 2011 at 9:14 am
(9) VIPUL CHAVDA says:

Mention of “Prevention” / Life style modification. “Trying” & encouraging exercise therapy is the key in joint healthcare.

Unfortunately importance of Diet, weight loss, Exercise Therapy & need to preserve what god has created is rapidly vanishing.

When one talks about “Awareness”, there is no mention of Rehabilitation at equal level to “REPLACEMENT SURGERY”?

The KEY is a correct choice of “CLINICAL CASE”.

The choice of Replacement should be when conservative management has failed. (Sincere approach to weight loss, Sincere rehabilitation)

Replacements surgeries are boon to patients who genuinely need it. But at times people get tempted like they would for a new car!!!! Long term results are very good if one follows
1. Weight management
2. Unloads the joint
3. Avoids active sports (high Impact)

January 11, 2013 at 1:59 pm
(10) Rto82 says:

This is for JaNell. You said you’ve had TKR on both knees & you’re 35. I’m 37 & looking @ TKR on my right knee now & prob in 5 years or so on my left. I’ve had lateral release, medial reefing, partial menisectomy & micro fracture on both knees. It has not worked. I have valgus knee which won’t be corrected until TKR. I’m just curious why you had to have TKR so young.

March 16, 2013 at 8:31 pm
(11) Krs1450 says:

I’m 37 and getting my left knee replaced next month, and the right one probably in the fall. I have valgus knees that are steadily getting worse & there is no other option. I have had 3 knee surgeries, countless injections, therapy and medication. I’m not overweight & I am an active person, although limited by my deformity. I am nervous about the surgeries, but so looking forward to the final outcome!

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