Joint replacements are increasingly offered to active patients at younger ages, but those considering surgery need to be realistic about the risks and benefits.
Less than two weeks after having his left hip replaced, Jean Philippe Adam set aside his cane and did a little dance in his doctor’s office.
Adam, an avid tennis player and father of three, was 50 years old at the time and proud of his speedy recovery.
Two months later, he was back on his local courts in Westchester, New York, cautiously playing singles tennis.
Now 52 and playing tennis two to three times weekly, he has no regrets about surgery.
For two years before the procedure, arthritis caused Adam increasing discomfort, to the point that even walking and hiking became difficult.
He tried cortisone shots, pain relievers, and physical therapy — but he was still limping through tennis matches in excruciating pain.
Now that pain is gone.
“It’s a typical story where I wish I had done it sooner,” Adam told Healthline. “It took some time for me to digest the fact that I had to go to surgery at 50.”
Adam isn’t alone.
His experience is part of a larger trend, according to his physician, Dr. Calin Moucha, chief of Adult Reconstruction and Joint Replacement Surgery at The Mount Sinai Hospital in New York.
In the past two years, Moucha and his colleagues have noticed a 15 percent increase in patients under 60 having hip and knee joint replacement surgeries.
Their observations align with recent research.
For example, a study presented last year at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that the number of total hip replacement surgeries nearly doubled among patients ages 45 to 64 between 2002 and 2011.
“We’re just seeing a lot more younger patients,” Moucha told Healthline. “Patients are realizing that they don’t want to live in pain.”
To some extent, the rise in joint replacements among younger patients comes down to demographics and lifestyle.
Baby boomers, now middle-aged, are second only to millennials as the largest living generation, and are much more active than their parents were.
At Mount Sinai, which was the official hospital of the U.S. Open, Moucha and his colleagues see an exceptional number of patients who play tennis.
Moucha said that after a knee or hip replacement, “what’s dramatic to me is that a lot of these patients are able to return to tennis in a really exceptional capacity.”
That’s a fairly recent development.
A decade ago, surgeons often advised against joint replacements for younger patients, mainly offering the procedures to those 65 and over.
“We wouldn’t even consider joint replacement on someone until they were completely disabled, using a walker, and on a lot of medications,” Moucha said.
For patients in their 40s and 50s, especially those who are active, there’s a risk that the new hip or knee joint will wear out — forcing them to undergo a second surgery.
Surgeons also used to be much more conservative in their advice to patients about post-operative exercise, especially for high-impact sports like tennis, hockey, and running.
Moucha explained that patients feared a joint replacement meant giving up favorite sports.
Today, he said, “They’re shocked when I tell them they’ll be able to go back to playing tennis.”
Advances in technology are a big part of the reason joint replacement procedures can make sense for younger, physically fit patients.
Replacement joints now last longer and work better.
In one study presented at the 2014 Annual Meeting of the AAOS, researchers found that the Charnley hip prosthesis was still functioning in most patients after 35 years of use.
Although active, middle-aged patients still run the risk of needing a repeat surgery later in life, many are unwilling to wait in pain, sidelined from activities they love.
“I don’t focus now on what’s going to happen in 20 years,” said Adam, who has played tennis since childhood. “Playing through the pain was not an option for me.”
Surgical techniques have also improved significantly.
Orthopedic surgeons now have a better understanding of how to perform joint replacements with as little damage to the surrounding muscles as possible, Moucha explained.
There’s also uncertainty about the extent to which playing sports after a joint replacement actually increases a patient’s risk of injury.
These days, rather than telling patients to take their sports play down a notch, some surgeons let patients push themselves, with caution.
After surgery, Moucha typically advises patients to wait about three to six months before easing back into high-impact sports like singles tennis.
Adam, who agreed to monitor himself carefully when he returned to singles tennis after just two months, was an exception.
Even for knee replacements, which generally have lower patient satisfaction rates, Moucha said it isn’t clear cut that patients have to reduce the intensity level of their sports.
“The implants are better, the techniques are better, and we’re doing better surgery,” he added.
But neither surgery is a magical cure-all for arthritis pain.
It’s a fact that Dr. John Ginnetti, an orthopedic surgeon at University of Rochester Medical Center, has to regularly remind middle-aged patients who have high expectations that a joint replacement will significantly ease pain they experience when playing sports.
“A lot of our discussion preoperatively with patients is trying to manage their expectations,” he said. “For some, they think it is like, ‘I’m receiving my joint from when I was 25 again.’”
Ginnetti said that he encourages patients to continue with sports they love.
But he noted that, especially for knee replacements, patients tend to experience more residual symptoms, such as pain, with increasing activity.
There are also risks when patients push themselves too quickly after a joint replacement.
“We find that patients are doing a little bit too much,” he said. “The body probably does need a specific amount of time to heal, and you may be doing yourself a disservice by doing too much, too soon.”
In a hip replacement, it’s important for the patient’s bones to grow into the components of the new joint — and high activity right after surgery can disrupt that process.
For knee replacements, there’s a risk that too much movement may irritate the knee and increase swelling, which could interfere with regaining range of motion in the joint.
Ginnetti emphasized that patients should see joint replacements as a long-term investment.
“In the grand scheme of things, these surgeries were developed as a sort of salvage operation,” Ginnetti added, “not to improve your tennis game from being a ‘B’ player to an ‘A’ player.”