Inspired by recent news that Billy Joel had double hip-replacement this week. He’s only 59. It seems like I read about guys over 50 getting replacements very frequently these days. Much, much more than twenty or thirty years ago.
Looking back on both sides of my family, no one ever had any hip problems. They all lived into old age and never had any hip pain.
Why are middle aged white guys suddenly developing hip problems? Is it the office worker lifestyle? Does genetics play a role? I rarely hear about black males (excluding athletes) having this problem. Women also seem to have less hip issues.
It’s interesting that older generations (my grandparents & great grandparents) walked more and did hard physical labor their entire lives. Modern adults grew up traveling in cars, and working indoors. Yet, they are the ones with hip pain in middle age.
Are there any stats on this or research on why more men are having problems?
From my interpretation of the press release about BJ, it sounds as if he may have had congenital hip dislocations (also called congenital hip dysplasia) and subsequent severe, premature arthritis (see here). So, not really typical of middle-aged men.
Also, in previous years, hip replacements did not last that long. And they were very hard to do a second time. So doctors tended to recommend against them for middle-aged patients, trying to deal with the problems other ways as long as possible. Otherwise a patient who had one in their 50’s would have it wear out in their late 60’s or 70’s, and what would they do them? Whereas if they waited to do the hip replacement, it would likely last until the patient died.
My mom had a knee replacement (yeah, yeah, I know, but same general idea) a few years ago, in her mid 50s. They’re doing replacements younger these days when they’re really called for. She’d injured the knee as a teenager and it had gotten worse and worse over time. The replacements are still very tricky the second time around, as there is a lot less bone to work with, but as they are built to last longer, it’s less of an issue over time.
Her new knee is doing fine and she doesn’t do anything stupid like ski on it. I work at a ski resort and once got a call from a woman in her 80s who was booking to ski with a group where you have to be 80 to join who told me she’d had a hip replaced the year before and was ready to hit the slopes. Though I doubt our guest was expecting her new implant to last 20 years or more anyway – skiing is definitely on the NO list. I certainly wasn’t going to say anything to her!
That group kicks ass. They’ve been skiing as long as my mom has been alive in some cases, and not for much less time in most others. I am impressed.
ETA: I didn’t really read the last post in the thread, but yeah. Didn’t mean to repeat too much.
Also, in previous years, hip replacements did not last that long. And they were very hard to do a second time. So doctors tended to recommend against them for middle-aged patients, trying to deal with the problems other ways as long as possible. Otherwise a patient who had one in their 50’s would have it wear out in their late 60’s or 70’s, and what would they do them? Whereas if they waited to do the hip replacement, it would likely last until the patient died.
Men and women have different hip structure, this would be my first clue. Women’s different hip structure is so they can have children, might also save them the pain of replacement of hips.
I remember reading somewhere in a martial arts book that the western use of the chair has a bad impact on the hips, shortening the hip flexor muscle, possibly limiting use of the joint. Hip replacement seems to be necessary when an arthritic condition develops, which is an inflammation or degeneration of the joint. Maybe a use it or lose it state of affairs.
So working out doors more and sitting less would use the joint much more, sitting all day might degenerate it.
Not sure about that, but I did a bit of reading up on hip replacements and decided I would have to be in serious extreme problems before I would consider one - you can not sit crosslegged … :eek: Totally forbidden. Sorry, that is one of my most comfortable positions [I am extremely uncomfortable in the traditional sit upright in a chair with the feet on the floor in front of you position. It hurts after a fairly short time. I am too accustomed to sitting crosslegged.]
I have enough joint issues, I can’t sit on the floor, a squat toilet is right out, and if a chair is too low I have issues sitting down and getting back up again, but not to be able to sit crosslegged ever again? /me sobs
[I have [femoroacetabular impingement](http://www.hipfai.com/) in both hip joints, and my sacrum is also shot]
That sounds painful, my knowledge of western medicine is so pitiful, I would take what I say on matters with a grain of salt.
I know that daily stretching for many is not commonplace. I could see benefit there, but as to the technical aspects, I’m at a loss.
Pain sucks, I hope you find a way to do the things you like and need with out it.
I think the OP is correct in his line of question though, joint issues are on the rise. The ethnicity point he makes is interesting… but I have nothing on that.
I also agree that the OP has a point about the lack of just plain moving around and walking. I have noticed that in the small town that my mom lives in [and my parents bought the house in IIRC 1970] that over the years it has gone from kids walking to school and people walking to the town center to go to the drugstore, pizza place, library or IGA to everybody driving everywhere and kids being bussed. I saw the busses stop for a middle school aged kid 3 blocks from school. When I went, if I had not actually gone to a private school elsewhere, I would not have qualified for a bus ride, and our house was just inside the 1 mile bussing limit. [I would have had to live on the other side of the small graveyard to qualify]
As recently as 3 years ago [last time I could really manage to walk with nothing more than a cane] mrAru and I decided to walk to the IGA to pick up some subs from their deli, and I swear we could have been martians from the stares we got from the people driving past us :eek: Growing up, we walked or biked around town for stuff … now it seems that nobody in town walks.
I’ve walked to places all my life growing up in a village, and biked, too. Moving out to the sidewalkless suburbs in the middle of nowhere, I’ve occasionally walked up to the Rite Aid, which is the only place within walking distance to buy anything of use. But It’s hella scary creeping along the shoulder of the road, and trying to cross that road requires as much bravery as parachuting. There’s so much more traffic now, so many more cars on the road.
Nothing to add about hip replacements, but I know a LOT of people who’ve gotten knee replacements.
I think people used to just suffer more. I am 34, and when I was 8-10, I knew a LOT of people in their mid-60s and older who were effectively housebound due to joint pain. There’s a reason the traditional retirement age is 65: for much of history, a significant portion of people 65 and older weren’t physically capable of working. These days, we don’t think of 65 as 'creaky, shuffling old", but 20 years ago, it was.
And on the other side of the activity spectrum, the people I know who are getting hip and knee replacement do lots of walking - letter carriers that walk their routes. My husband is a letter carrier, and his coworkers tend to get at least their knees replaced starting in the mid-40s or a little later, with hip replacements not uncommon either. These people walk several miles a day at least, carrying a heavy bag of mail as well.
Hm, maybe different shoes and orthotics could help? Something concentrating on the heels and ankles I should imagine [thinking about the anatomy of walking]
I know that getting orthotics made walking and standing more comfortable for me, probably has extended my ability to occasionally just gimp around with crutches by at least a year so far. It did noticeably change my standing posture and gait. [And the physioterrorism also helped a lot]
Hip replacement is a difficult surgery, and a fairly modern one. The first successful surgeries were just before WWII and the modern technique for them wasn’t introduced until about the 1970s.
Even at that time, they were expensive, required long convalescence, and were limited to expert surgeons and hospitals. You didn’t see them very often because almost nobody had them.
Surgical techniques have been revolutionized over the past couple of decades. Laproscopic surgeries, remote viewing, new materials, better rehabilitation makes for totally different success rates over a tremendously larger pool of candidates. That’s why you see them in so many people who never would have been considered as candidates earlier, and who couldn’t afford to have them done in the first place.
Peoples’ bodies, occupations, exercise, and ergonomics are tiny factors compared to the simple, overwhelming one that the operation itself has turned from very rare to routine.
Not sure walking is a very complex uses of lots of different muscles. There are places that do studies on it, and dole out individually tailored advise, if you suspect something you might look into one.
The single most significant factor driving total hip arthroplasties is a lowered threshhold for surgical intervention. It would be almost impossible to construct a study which determines the incidence of crummy (native) hips 50 years ago.
What lowers the threshhold for surgical intervention?
Availability of healthcare, including the number of orthopedic surgeons and the remuneration for doing procedures. This does not mean the surgery is inappropriate. It does mean an individual with hip pain is more likely to be formally evaluated and offered a surgical alternative to chronic pain.
Technical advances for arthroplasty. Such advances include safe anesthesia, minimally invasive surgical techniques, and advances in prosthetics. These and other factors skew the threshhold toward surgery because the drawbacks of surgical intervention become increasingly trivial.
I haven’t seen studies about whether or not there is more underlying pathology precipitating hip replacements in the first place, and I’d be interested if someone can find and post such a cite. As I mentioned, it might be difficult to figure out how to do it. I doubt a change in genetics is involved, but other factors might be interesting to look at. Obesity increases stress on joints. We’re getting fatter. High-impact sports increases stress on joints. Maybe our high-school sports programs or exercise culture is beating up our joints too much. A sedentary life can’t be good for increasing bone density. Or maybe we’re sun-screening our Vitamin D away. And so on.
I recently had a Hip Resurfacing. The business about not sitting crosslegged is one of the precautions imposed on Total Hip Replacement patients during their recovery to lessen the possiblity of dislocation, but it is usually imposed only during the first two months. For Hip Resurfacing, the only precaution is not to lift more than twenty pounds for a few months. I started a thread about my experience here. I have no idea whether Resurfacing is appropriate for you, but I don’t think you should rule out either procedure based on the crosslegged thing. It can be a life changing procedure. I am 60 and feel as I did when I was 50.
To answer the OP, one reason is that there is big money behind these operations and the companies that make the appliances are out there pitching their wares to surgeons all time, but mostly it is what Chief Pedant said. The standard advice (which was given to me about 8 years ago) is wait until you can’t wait any longer, i.e. until your daily activities become severely limited without a great deal of pain. They said his because they estimated the average life of the appliance to be about 15 years, and replacing a Total Hip (called a revision) is a much more serious operation. The appliances are now thought to be longer lasting, so they are willing to do it sooner. In the case of Resurfacing, the Revision is much simpler.
My father and my grandmother have both had their hips replaced. Dad had some sort of sports injury when he was in his 20’s that never quite healed properly. He is/was very active in sports and the like, but at one point the doctor told him the old injury is going to catch up to him and he will need a hip replacement around age 50 or so. He put it off as long as he could, until 54. It is expected to last the rest of his life. He did quit the softball league, but still goes to the gym and bowls regularly.
My grandmother (not his mother) had hers done at 80, just a few years after my dad had his done. She decided when she couldn’t walk the golf course any more, it was time to have it done. She felt better seeing his recovery and knowing he was back to most of his old activities pretty quickly after surgery. She had hers in August 2009 and was golfing in Myrtle Beach by winter. Her physical therapist was an integral part of her recovery and Grandma loved him. They are Canadian, so he came to the house to do PT. My grandmother did office work most of her life, but was very active physically. She is back to her normal activities with little to no trouble.
My familial N of 2 shows no gender preference, although the middle-ager was male, but that was due to a prior injury.
To be honest, I don’t think I could last a week sitting ‘regular’ in a chair for as long as I tend to remain in one place. I use my wheelchair for movement, if I need to be out and around and move more than a hundred yards or so, or stand for more than 5 or 10 minutes. Right now, my pseudogout hasn’t stopped flaring for almost a month and a half, no matter how faithfully I hork down the damned colchicine, mouth sores or not so other than transferring into and out of the car, and the toilet, it has been wheelchair and bed.