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Surgeon attitudes shifting about joint replacement in younger patients

May 6, 2013 1:11 pm by | 0 Comments

hip joint

CHARLESTON, W.Va. -- Jessica Boggs, 30, isn't sure what made both of her hips deteriorate just over four years ago.

"In November of 2008, I woke up one day and could put no weight on my left leg. It was throbbing," the Charleston resident said. "My primary doctor thought I pulled a muscle. In January 2009, I got an X-ray, and it showed my bones starting to deteriorate rapidly."

She went through four surgeries, two to save the bone with plates and screws. By February 2010, both of her hips had been replaced. Her condition forced her to use a wheelchair, crutches and a cane.

"It was a pretty emotional time. I was bedridden. It had a lot of emotional effect on me," she said. "You have no access to the outside world. You feel so helpless because you can't go out on your own. But I came out stronger because of it.

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"We have no idea -- there was nothing in my medical history to show this. I wasn't obese. I don't smoke. I haven't taken steroids. We just have no idea; It was a fluke case," Boggs said.

The average age of people needing joint replacement surgery is getting younger, said Dr. James B. Cox, orthopedic surgeon with Teays Valley Orthopedics.

"Typically the population who undergoes hip or knee replacement surgery is an older set," Cox said.

"But we are seeing younger and younger people who require hip replacement surgery."

The average age range 10 years ago would have been 70 to 75, he said. Now, the average patient is 65 to 70. Some are much younger.

Dr. Phillip Surface, an orthopedic surgeon at Ortho Clinic in South Charleston, said about 15 percent of his patients are younger than 50.

There are several possible reasons problems are starting earlier in life.

It's no secret that obesity remains a problem nationwide. Among the myriad risks associated with being overweight is wear and tear on joints.

Extreme sports also have seen an increase in popularity, leading to more sports-related injuries.

"It may be related to lifestyles -- a certain group of people who are more athletic -- and they're wearing their joints out quicker," Surface said. "You have another group of younger folks on the opposite end who are not as healthy. Diabetes and obesity are more prevalent. These two groups of younger people are showing up with bad joints."

But another factor is a simple change in philosophy among doctors, Surface said.

"Some of that change is coming from the orthopedic surgeon community itself . . . People who trained in the East Coast were very conservative about hip and knee replacements in young people and would avoid it," Surface said. "The West Coast mentality was if they need it, do it. The attitude is shifting from the West Coast here."

Joint replacements in younger people were sometimes avoided because of possible complications.

Artificial joints wear out faster than natural joints, and the person was likely to need another replacement surgery in 10 to 12 years, Surface said. The second surgery tended to be much more complicated, and the outcomes aren't as good.

In addition to a mindset shift and advances in technology, people are developing arthritis at younger ages.

Cox said when doctors would see arthritis in younger patients -- in their 40s, 50s and 60s -- they would try to hold off on joint replacement because he would expect a joint to last 15 to 20 years at the most.

"Some implants that are available to us now, we expect them to last a lifetime," he said. "With that in mind, we're not as reluctant to move forward with hip replacement."

Like many people who receive joint replacements at an early age, Boggs likely will have more surgery at some point. She hopes to get 20 to 25 years out of each hip, and she hopes for technology advances by then.

Until then, she is happy being able to walk and run as she used to. While she steers clear of skiing or anything that might put her at risk for new injuries, she has seen no complications from the surgery.

There was a least one silver lining during Boggs' ordeal. She met her husband while going through the experience. On their first date, he carried her up 25 stairs because she couldn't walk on her own.

"He walked into my life at my lowest. I don't want to go through that again, but I did meet my husband through it," she said.

Contact writer Candace Nelson at [email protected] or 304-348-5148. Follow her at www.twitter.com/Candace07. ___

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By Nelson, Candace

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