injured knee might need surgery

More people at increasingly younger ages are receiving knee replacements.

When a medical procedure suddenly becomes commonplace, it’s hard to know if it’s a good news story or a cause for concern. Consider knee replacements, which Brigham and Women’s Hospital (BWH) research shows have become increasingly common in recent years.

For anyone who has suffered from the symptoms of severe knee osteoarthritis, today’s relative ease of access to knee replacement surgery is good news. (Most knee replacements are performed to treat osteoarthritis – the breakdown of cartilage in joints.) On the other hand, artificial knees are typically expected to last only about 15-20 years, which could be a problem for the increasingly youthful patients now opting for the surgery.

In 2009, the number of total knee replacement surgeries performed in the U.S. reached more than 600,000, double the number completed a decade earlier. Perhaps more surprising to researchers, however, was the disproportionate growth in knee replacements among younger patients – those aged 45 to 64. With this recent upsurge in patients receiving knee replacement surgery earlier in life, 1 in 20 adults aged 50 or older now can claim an artificial knee. The research was led by Elena Losina, co-director of the Orthopedic and Arthritis Center for Outcomes Research at BWH.

Increased activity among adults of all ages may be partly to blame for the uptick in knee replacements. Because today’s adults are more likely to be active in sports, they’re also more likely to sustain injuries at younger ages, which in turn can lead to knee osteoarthritis in earlier years. Not willing to sit on the sidelines, these active adults are also more willing to undergo surgery in order to maintain that energetic lifestyle well into their golden years. On the flip side of the coin, however, the nation’s growing rate of obesity (which puts strain on the knees) is also at issue.

knee replacement research team

Knee replacement research team (left to right): Thomas Thornhill, Jeffrey Katz, Alexander Weinstein, Elena Losina, R. John Wright, Benjamin Rome

There are other factors at work, too. Over the past 20 years, knee replacements have enjoyed increasing success rates – which make surgeons more willing to offer them and patients more likely to elect them. Another plus: Patients today experience shorter post-operative recoveries. A decade ago, most patients required a week-long hospital stay after surgery. Now, they usually return home just a few days after the procedure.

Whatever the cause, however, researchers are concerned about the overall public health impact of this growing number of surgeries. As more and more people at increasingly younger ages opt for knee replacements, the next frontier of knee surgery may be dealing with (or heading off) the long-term complications that can result from living with a knee implant and the revision surgeries that may be required for those who outlive their implant. “The findings suggest that life with knee replacement should be thought of as a chronic condition that is just as prevalent as rheumatoid arthritis or congestive heart failure,” says Alexander Weinstein, a co-author of the study.

This may lead to higher health care costs. According to Dr. Losina, the study findings will be helpful as health care systems plan services for younger patients with replaced knees. Services may include preventing and managing fractures and infections surrounding the artificial knee, as well as planning for revision knee replacement surgery.

“This data could help physicians and surgeons have discussions about consequences of having total knee replacement earlier in life,” notes Dr. Losina. With so many young, active patients undergoing knee replacement, “further research is required to understand how such high levels of physical activity will affect implant longevity,” adds Benjamin Rome, a co-author of the study. Sure, knee replacements may help adults stay active now – but will their knees continue to support a dynamic lifestyle 20, 30, or more years down the road?

– Linda W

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