Too young for a knee replacement??

By the time she was 40, my sister-in-law was suffering from bad arthritis in both knees. Her orthopedist told her that she could stave off looking at knee replacement surgery if she did the following:

  • Took anti-inflammatory meds
  • Lost weight (she’s at least 100 pounds overweight)
  • Started to exercise

She did the first one, but that’s it. And, she wound up having both knees replaced when she was around 46. She’s still extremely overweight, and still doesn’t exercise. I don’t know what counsel her surgeon gave her about additional replacements down the road, but I also suspect that she’s decided she’s not living a long life, anyway. :frowning:

Another anecdote about knee replacement complications: a friend of mine, who was also suffering from severe arthritis in his knee, had it replaced about 18 months ago (he’s in his early 60s). While this was his first replacement, he suffered from extreme complications due to an infection that set during the initial recovery period, and which they could never get entirely under control. They wound up removing the joint, and putting in a concrete “spacer”, to give the tissues a chance to heal (which left him immobilized), but after nearly a year in and out of hospitals and long-term-care centers, his doctors finally determined that the entire sequence had left his leg so damaged that they wouldn’t be able to put in a new joint, and he wound up having the leg amputated above the knee.

I had a knee replacement at 40, and the surgeon told me that I could expect it to last 15 to 20 years.

I think my case was not typical. I’d had a horrendous accident about four years before that, in which a spike was essentially driven through my knee. I had surgery to screw and wire it all together, but it just kept deteriorating, despite several more surgeries, to the point where the last doctor I saw said that basically there was nothing more that could be done, and I’d have to have a knee replacement.

It was like magic. I’d barely been able to walk for the past few years, and all of a sudden I was just fine. I could walk as far as I wanted, for miles, over rough terrain, wearing any shoes I wanted. I could do 75-mile or more bike rides. No pain whatsoever.

The recovery wasn’t bad at all. I was back at work exactly one week after the surgery (I work a desk job, probably wouldn’t have been the case if I was on my feet all day, carrying heavy loads). I did some physical therapy, which helped with the range of motion.

And now I’m at the 15 year point, wondering if it’s all going to fall apart. Will it be all of a sudden? Will it be a slow, or fast, deterioration? I have no idea. But it seems certain that I’ll have another replacement soon enough.

From my admittedly limited understanding (I do a lot of aftercare for joint replacements as a nurse, but I’m not involved in the pre-surgical counseling or education part) it’s not so much that the replacement parts wear out as that the bone wears down. You only have so much bone, so when it wears away, there may not be enough left to attach a new replacement to.

I will add this in case anyone Googles knee replacement and finds this thread: DO YOUR PHYSICAL THERAPY!!! If you know that you’re the kind of person who won’t do the exercises they give you every single day like they tell you…just don’t even bother getting the knee replaced. Seriously. You won’t feel any better, and you may feel significantly worse. I cannot overstate the importance of Physical Therapy after knee replacement. I just visit to make sure you’re not getting an infection or a blood clot and try to make sure you’re not likely to overdose on pain meds. The Physical Therapist is way more important than the nurse or the doctor in overall healing and ultimate patient satisfaction, but even the Physical Therapist isn’t as important as YOU actually doing the exercises.

QFT. This is the most important thing.

Qadgop (and anyone else who might have any information, like WhyNot), I’m interested in any thoughts you might have about non-traditional forms of pain management for people with severe knee arthritis (i.e. NSAIDS, tylenol, narcotics). My colleague is very interested in chronic pain management, and so I’ve heard a bit from him, but I was wondering about your professional experience and anything you’ve found in the literature. I’ve read some data re: biofeedback, and less re: yoga. I’ve also had some anecdotal success with acupuncture. Any thoughts?

Before I became a nurse, I worked for an acupuncture/herbal/bodywork clinic, and there were some great success stories. There were also some people that weren’t helped as much as they liked. I think it’s important to remember that while we, as doctors and nurses, do our best to provide suggestions based on evidence - because that’s the ethical thing to do, is to recommend what helps the most people, most of the time - the fact is also true that you are one individual. Statistics tell us what works for large groups of people, but there’s always someone in the study group that the intervention helps, even if it doesn’t help enough people to be statistically significant. So, as a nurse, I’ll tell you that there is some evidence in favor of acupuncture and massage for management of musculoskeletal pain, and that they’re continuing to do more studies, but there’s not Grade A unequivocal evidence in favor of them yet. As a person, I’ll say, if you can afford to try it, why not? It’s almost certainly not going to do harm, and knee pain is not an emergency situation where delaying more strongly evidence based practice is going to put you in danger. As we see from the premise of the thread, doctors generally want to delay knee replacement as long as possible anyway; might as well try something else in the meantime. And if you’re one of those people whom it helps enough to avoid surgery, that’s a win!

Narcotics for long term OA pain? Nope. Bad idea. *Really *bad idea. Narcotics don’t work well long term, there are the well known addiction and dependency problems, overdose potential, and there’s something called Opioid Induced Hyperalgesia, which means that some people on narcotics long term develop an overly sensitive pain reception, and get new and exciting pain from the narcotic use. A light brush on the arm can become painful. And that OIH pain does not respond well to increased doses of narcotics, and it doesn’t always go away if/when you can stop the narcotics. So you get pain from your painkillers, and it’s a kind of pain we don’t know how to treat.

NSAIDS are tricky. They do a pretty good job, with OA pain, but they carry GI irritation and bleeding risks, and kidney damage risks and it now appears they may cause cardiovascular incidents, as well. Since all three of these are areas of concern for the same older people likely to have OA, it’s a therapy that needs to be carefully considered and monitored. Celebrex is my favorite NSAID at the moment, as a study was released (last week, I think?) showing that it does not seem to have the same CV risks as the others, and previous studies have found less GI issues. But it’s prescription only and can get pretty expensive, and basing decisions on the results of one study is usually not a good idea. So I’m watching that one, but can’t be terribly enthusiastic about it yet.

Tylenol is the best med for OA that I’m aware of, as long as your liver is happy and you don’t overdo it.

I’m also fairly fond of topical treatments, and think they’re not used enough. Voltaren gel gets a lot of good reviews from my patients, and good ol’ rubbing alcohol is not to be underestimated. (Funny baby nurse moment: when I started out, I had no idea why rubbing alcohol was called “rubbing” alcohol; turns out it’s an old remedy for topical pain relief, literally rubbed on the sore joints. I learned that from my older patients!) I also like capsaicin creams and oils, and many people find relief with menthol. My Physical Therapists are all big fans of something called BioFreeze, which used to be very hard to get, but now is available online.

Thanks for that info, WhyNot. I’m also the proud owner of a bum knee. My dad had terrible problems with his knees, and Dad’s doctor told him when he was in his mid 50s that he’d have to have his knees replaced sooner or later. Dad passed away at 59 before he had the surgery done.

I’m 41 and have inherited the same knee issues. I’m hoping that by the time I get to Dad’s age there will have been enough advances in knee replacements that maybe it can be a one-and-done kind of thing.

A lot of big box stores are carrying BioFreeze now, too, like the place where I work.

Ooh, that’s really good to know, as I have a lot of older patients who don’t do online shopping. Thanks!

My case is also atypical but I am going to chime in anyway. It annoys me when doctors tell people they’re too young for joint replacement, because it’s offensive to tell people to just live in pain. It’s too close to “suck it up, junior”. While the points that Qadgop and Whynot brought up are valid and I respect them, I think some doctors just don’t evaluate the patient’s specific case because they don’t want to deal with it. Okay, so my soapbox opinion out of the way, here’s my case:

I got a total ankle replacement at age 38. Best thing since sliced bread. I have juvenile rheumatoid arthritis, affecting my weight bearing joints since infancy. My ankles were a huge problem for my entire childhood and early adult life, but despite that I carried on like any other person who does not have arthritis. Meaning that when things hurt, I took NSAIDs but otherwise just sucked it up. In college I had a nearly full time job in fast food, which meant being on my feet on brick floors for 8 hours a day, 5 days a week. I’m sure that is what finally did in my right ankle (my left had been surgically fused for years at that point).

My rheumatologist told me about an excellent surgeon who was doing ankle replacements with new technology (bone ingrowth, not the epoxies that had a reputation for failure). I went for a consultation. Long story short, I skated through surgery and recovery and have never had one problem with it. I still have it and even though the general thought is that they last around 15 years, the last time I had it checked by the surgeon (a couple years ago) and asked him if it was almost at the end of it’s lifetime, he said “we’ll see, we don’t know yet how long they last”. Sure enough, I’ve had it for 16 years now.

I think people (ahem, doctors) should keep in mind that it’s possible that age will balance out some of the risks of surgery. In other words, the things that Qadgop mentioned may be better or worse depending on the patient’s age. Young people heal more quickly than older people. Young people tend to be generally more healthy also while older people may have some chronic issues that can cause complications. That’s why I think every case should be evaluated on it’s own merits rather than lazily defaulting to the “you’re too young” excuse.

Well, I don’t have any direct knee-replacement experience that will be helpful, but here’s an amusing anecdote.

When my grandfather was 80, he had to have bilateral knee replacements from 75+ years of square dancing, which is, apparently hard on your knees. My aunt (his oldest daughter) was very concerned about an 80-year-old man having that kind of serious surgery, and she asked him if he was worried about it.

“Worried? Ehhhh, no. I’ll be fine. When I die, I’m either gonna drop dead on the dance floor or be shot by a jealous husband.” :smiley:

Four years later, he was square dancing on his new knees, had a heart attack, and dropped dead on the dance floor.

Age and anticipated lifespan (of the joint AND the patient) should be just one facet of the evaluation, and not a definite rule in/rule out scenario. I regret it if I gave that impression.

But quality of life counts for a lot, too. I am not opposed to replacing joints early despite knowing they will likely wear out before the patient does, necessitating a riskier 2nd procedure. As long as the patient is informed of the risks and benefits by a surgeon willing to do the procedure, then due diligence has been done.

Found out today my sister is getting a Syn-Visc injection. I’m hoping it’ll give her some relief, and I’m sure she is too. She’s a bartender, so she’s on her feet for hours at a time at work - as you might imagine, a bad knee is really bad news.

Yeah - a friend who was looking at a hip replacement at a VERY young age (late 40s as I recall) was told to delay it as long as possible for those reasons. Ultimately she was told she wasn’t even a candidate due to the nature of the deformity. Another friend’s mother HAS had second hip replacements but the second one was done at a different hospital that specialized in difficult cases.

I have a friend who had both knees done when she was in her early 50s. She had spent years trying the joint fluid shots / steroid shots / pain medication, and finally couldn’t take it any longer. In her case, as I once put it “she’s kicking herself - or would if she could - for not doing it sooner”. At the time, I myself was experiencing significant knee pain so I was watching her progress with great interest (mine, fortunately, responded very well to joint fluid injections so the question has been delayed indefinitely for me but it could become relevant in the future).

I have another friend who also had both knees done at a similar age. Her improvement hasn’t been as spectacular as the first one, but I gather her level of pain is definitely reduced.

But in both cases, they’re looking 30+ years more to live, and when / if the replacements DO fail, they’ll be older and in poorer health.

I gather recent implant techniques and hardware are a lot better and “they” think the implants may have a much longer lifespan, but I also gather the data isn’t there to prove that just yet.

So to my non-ejumacated mind, it seems like they’re trying to work a tradeoff between young / healthy enough to tolerate / recover well, and old enough that it’ll last the rest of your life.

Excellent! That’s definitely a better first step than jumping on the replacement bandwagon. I had a series of 3 injections in my bad knee, a week apart as I recall. The shots weren’t terribly pleasant but weren’t all that bad, either (I’ve had steroid shots into my feet and the knees were a limp in the park by comparison).

Mine wasn’t Synvisc - for some reason, my ortho didn’t like that brand. I think he used Orthovisc. I remember being annoyed as hell because I had to order the stuff myself through the specialty mail-order pharmacy, to be shipped to the ortho’s office - for some reason they can’t use stock on hand for it (they can for Medicare patients). And it took the mail order pharmacy well over a month to get hold of the ortho’s office to arrange for shipping - pretty sure they lied about even trying to contact the ortho, as I finally had them make the call while I waited on the phone, and they got it done in about 5 minutes.