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Rebuilding Your Body

At 42, Sally Seeley was barely able to walk. Diagnosed with osteoarthritis in her late 20s, she tried a range of treatments from water aerobics to Vioxx. But her condition only got worse. Finally, an orthopedic surgeon recommended total hip replacement. She worried that she was too young for such surgery, but she just couldn't stand the discomfort any longer. "The pain was gone immediately," says Seeley, now 49. Three months ago, she had her right hip done; she's already back at work.

Joint replacement was once considered a last resort for elderly patients who were immobilized. Now, thanks to improved artificial joints made from longer-lasting materials like titanium, patients in their 50s and younger are signing up in growing numbers. More than 600,000 hip and knee replacements were performed in the United States last year. While the average patient was well over 60 years old, the number of people younger than 65 getting the surgery has grown by 20 percent over the past five years. "Maybe 10 or 15 years ago, the threshold was the ability to walk or do errands," says Dr. Edwin Su, an orthopedic surgeon at the Hospital for Special Surgery in New York. "Now it's continuing to ski, golf or windsurf."

Doctors compare joint replacement to replacing tires on a car that's out of alignment. Over the decades, your weight can wear down your bones. This is especially true for patients with arthritis, where inflammation destroys the cartilage surrounding the joint, causing the bones to grind together painfully. In knee replacements, the most common joint-replacement procedure, doctors cut into the joint and remove the damaged portions of the tibia (the lower leg bone), patella (kneecap) and femur (thigh bone). They are replaced with metal and plastic components. The surgery lasts at least two hours and requires general anesthesia. Artificial knees generally last from 10 to 15 years. Hips are the second most commonly replaced joints, followed by shoulders.

Who's a good candidate for this surgery? This is a treatment for people whose daily joint pain has severely curtailed their activity. Talk to your doctor, of course, but the procedure is elective--so you'll have to make the final decision. Most major insurance companies will cover the costs, which can exceed $20,000. Many patients say they opted to have the operation because the pain had ruined their quality of life. "I couldn't walk long distances, and I had a noticeable limp by the afternoon," says Frederick Kaskel, 60, a pediatric nephrologist who had a hip replaced three weeks ago. In traditional hip replacements, doctors replace the top of the femur with a metal ball and remove portions of the damaged hip socket. Kaskel got a new, less invasive procedure called resurfacing, which involves coating the ball of the femur with metal instead of removing it completely. Resurfacing is meant for patients with limited bone damage, which is determined by an orthopedic surgeon through X-rays.

If you think you may be a candidate for joint replacement, the American Association of Orthopaedic Surgeons ( aaos.org ) offers a list of board-certified doctors. Once you choose a doc, he or she will most likely order X-rays and recommend a type of replacement--plastic, metal or a combination of both--based on your health, age, weight and level of activity. Younger people should ask about newer all-metal models that are more durable over time. Since both the hip and the knees are load-bearing joints, you may need to drop some weight--losing just one pound takes three pounds of pressure off your knees.

A National Institutes of Health study reported that 90 percent of people with knee replacements reported fast pain relief, increased mobility and a better quality of life. Hospital stays range from two to 10 days, followed by months of physical therapy at home. Post-operative patients need to exercise daily. And while many patients can resume their active lives, it's not magic. "I'll be able to go hiking, but my wife will call a lawyer if I ever play racquetball again," Kaskel says.

As in any major operation, there are risks and drawbacks. Side effects can include infection or blood clots, but they aren't common. If you're young, you may need a second (or even third) replacement when new joints wear out. Another problem: patients with metal parts often set off metal detectors at airports. Seeley says she carries certification with her when she travels that she has had joint replacement.

But if science continues to evolve, that problem may all but disappear. "We'd like to replace [damaged] cartilage with cartilage grown in labs," says Dr. Tom Schmalzried from the Joint Replacement Institute at L.A.'s Orthopaedic Hospital. With any luck, we'll be able to cha-cha into our 80s.