Too Young for Joint Replacement?

Joint Replacement Surgery

Joint replacement surgery, often regarded as a "last resort" treatment, can render tremendous pain relief for patients suffering with severe arthritis.

The hierarchy of treatment plans for arthritis suggests that more simple and conservative steps be tried and exhausted. Before surgery is ever considered, a number of conservative treatments are recommended for the arthritis patient including:

• a variety of medications
• physical therapy
• joint protection
• rest
• exercise

Even by the time surgery is presented as a treatment option, a physician will likely choose simpler procedures such as synovectomy before joint replacement.

The intent is to get the best result with the most conservative approach possible. Though joint replacements are viewed as a highly successful surgical option, they are also viewed as mechanical parts with limited lifespan. When joint replacement surgery is indicated, the goals are to:

• achieve pain relief
• regain function
• correct deformity
• prevent further damage

Pain relief is the primary objective since function is not usually completely restored.

Younger People With Arthritis

Researchers from the Mayo Clinic in Rochester, Minnesota, reported in the Journal of Bone and Joint Surgery (2003;85A:1090-1094) excellent results from knee replacement surgery in children and teens with juvenile rheumatoid arthritis in terms of pain relief and improved function.

Thirteen young patients were followed for an average of 11 years post-op. Prior to surgery, two of the 13 said they could not walk. The others walked indoors only or for short distance outdoors. At the end of the follow-up period, six patients reported they could walk more than six blocks. One patient remained wheelchair-bound. Researchers added that 4 of the young patients had to undergo additional surgery though and many experienced complications of surgery.

The limited lifespan of the prostheses suggest that revision surgeries will be necessary in the future to correct for their failure. Each subsequent surgery is more complicated than the preceding procedure. The realization that younger patients will require more revisions leads some doctors to dissuade their patients. In the case of younger arthritis patients, the benefits and risks of surgery must be carefully deliberated.

Considerations

The Duke University Medical Center Book Of Arthritis proposes that the following questions be considered by any person deciding on surgery:

Pain Level

Is your pain unacceptable? Constant pain that does not respond to other treatment, keeps you awake at night, and interferes with work or activities is severe enough to require surgery.

Painkillers

Do you require narcotic pain relievers? If you require daily medications at full allowable dosage to control pain, surgery may be indicated.

Pain Management

Have you tried all other options to achieve pain relief? If the use of arthritis medications, physical therapy, rest, exercise, joint protection, remittive agents, and steroid injections has yielded unsatisfactory results, surgery may be a valid choice.

Rehabilitation

Are you prepared to conscientiously follow a rehabilitative regimen? You must be psychologically prepared for months of exercises and physical therapy to restore joint function following joint replacement surgery.

Physical Condition / Realistic Goals

Are you in good physical condition? Risk of complications will be low if your overall physical condition is good. Are your goals realistic? The rehabilitation process and the expected outcome of the surgery must be viewed realistically. Joint replacement surgery is not a cure, but it should offer restored comfort and function.

Risks Vs. Quality Of Life

Some patients end up in wheelchairs as they wait to grow old enough to be considered a candidate for joint replacement surgery. Surgery is delayed based on anticipated complications. Yet the opposite perspective of some doctors is that the severity of the disease and loss of function warrant the surgery regardless of age. It becomes a quality of life issue with the benefit of enhanced quality of life weighed against potential risk. Advancements in the design of joint prostheses are leading to better long-term results.

Related Resources

_{Sources: Journal of Bone and Joint Surgery, 2003;85A:1090-1094; The Duke University Medical Center Book Of Arthritis, David S. Pisetsky, M.D., Ph.D., 1992}