Knee Replacement in Young Patients

Total knee replacement surgery has long been used to treat severe arthritis in elderly patients. However, concerns arise when a patient in his 40s or 50s has severe knee arthritis that is not relieved with conservative treatments. Once reserved for elderly patients, total knee replacement surgery is becoming more common in the younger, active population.

How Young is Too Young?

No one can definitively answer this question, but what we do know is that the benefits of performing total knee replacement surgery in younger patients may outweigh the risks of surgery. The benefits are primarily quality of life, pain reduction, and maintaining proper fitness. By accomplishing these goals, patients may also reduce the risk of developing other problems associated with poor fitness such as cardiovascular disease.

The primary risk of performing total knee replacement surgery in younger patients is the concern of wearing out the implant. Developments in manufacturing have sought to reduce the magnitude of this problem, but it is a concern. Furthermore, the amount of wear to a knee joint replacement does appear to be related to the amount of activity. Therefore, young patients with joint replacements should be cautious, and perform only suggested activities (see below).

The Knee Society recommends specific activities for patients with total knee replacement, these include:

• Cycling
• Calisthenics
• Swimming
• Low-resistance rowing
• Skiing machines
• Walking & Hiking
• Low-resistance weightlifting

Activities which The Knee Society specifically recommends to be avoided are:

• Baseball
• Basketball
• Football
• Hockey
• Soccer
• High-impact aerobics
• Gymnastics
• Jogging
• Power lifting

These lists are meant to give patients an idea of what to expect if they undergo knee replacement surgery. Before you begin a new exercise program, it is important that you discuss this with your doctor. If there is an activity you do not see listed, and you are curious about your participation, ask your doctor.

What Are the Results of Knee Replacement in Young Patients?

Dr. Michael Kelly of the Insall Scott Kelly Institute of Orthopedics in New York City reported results of a study of 84 patients all younger than 55 years old. Of the 84 patients, Kelly found 82 patients improved their level of activity following knee replacement. After 18 years of following these patients, he found 94 percent of the knees were still working well. This data strongly support the idea that in young patients with severe degenerative arthritis, knee replacement may be an excellent option.

_Sources:

Beadling, Lee; "TKA can be an option for the young active patient." Orthopedics Today: Vol. 23 No. 10. October 2003 (Page 43).

BJ Cole and CD Harner "Degenerative arthritis of the knee in active patients: evaluation and management" J. Am. Acad. Ortho. Surg., Nov 1999; 7: 389 - 402.

Colwell CW, et al. "In Vivo Knee Forces During Recreational Activities After Total Knee Arthroplasty" Presented at the annual meeting of the American Academy of Orthopaedic Surgeons, San Francisco, March 5-9, 2008.