These operations to hips and knees aren’t just a last resort for the elderly, says Dr Melanie Wynn-Jones
As more of us stay active well into middle age and beyond, the number of people under
the age of 60 choosing to have hip replacements has increased by 76% to 18,000 a year in just 10 years, according to the Health and Social Care Information Centre.
The total number of hip replacements increased by almost half, and more younger men and women are also having knee replacements.
While there are simply more people in their sixties now than a decade ago, this trend has also been driven by better techniques, materials, and ‘use-by’ dates.
Hip replacements can now last 20 years, reducing the need for more complex (‘revision’) operations, although younger patients will often need one.
Who needs them?
Most hip and knee replacements are performed for osteoarthritis – disability and pain on walking, caused by gradual wearing away of the slippery cartilage covering internal joint surfaces, with damage to underlying bone.
You may also notice pain when resting or at night, grating, swelling and stiffness, although X-rays don’t always match up with the severity of symptoms.
People with inflammatory arthritis, such as rheumatoid arthritis, developmental hip problems or fractures may also need joint replacement.
They can help if painkillers can’t control your pain, if walking and other daily activities are extremely difficult, or if your quality of life is significantly affected.
But they may not be right for you if you can’t manage the essential rehabilitation programme, you’re at high risk of complications (for example, because of poor circulation), or the cause of your problem continues.
Once the specialist has decided joint replacement will help, he’ll discuss with you exactly what he’ll use and why.
You’ll probably have both the ball and socket part of your hip joint replaced, but there’s a wide range of metal, synthetic and ceramic alternatives with various pros and cons.
Hip resurfacing is sometimes suitable instead.
This is where the pelvic ‘cup’ is replaced with metal, and the arthritic surface of the thighbone ‘ball’ is shaved and resurfaced with metal.
Knee replacements may be total, or only involve one compartment (either side, or the kneecap) if the others are still healthy.
You’ll have a pre-operative assessment (including blood tests, a heart tracing/ECG and swabs to detect superbugs such as MRSA) to check you’re fit enough for an operation and general anaesthetic.
If not, you may be offered a spinal anaesthetic injection instead.
You’ll also be advised about temporary adaptations at home, and arranging additional support for you or your carer if needed.
Strict hygiene precautions during and after your op will minimise the risk of infection; you’ll also have injections to reduce the risk of blood clots in your leg veins.
What happens next?
You’ll probably only be in hospital for a few days and your physiotherapy rehabilitation – walking! – will start before you leave.
You’ll also be told what not to do (such as crossing your legs) and will need crutches for several weeks.
You should be able to resume driving, work, lovemaking and most of your usual activities soon after that – although ones that risk falls (such as skiing) are best avoided.
You’ll be seen as an outpatient at six and 12 weeks, and at one year; if all goes well you’ll be seen again after five years.
5 Ways to prepare for the surgery
1 Get as fit as you can with short, frequent periods of activity.
2 Ask about pre-operative exercises, to strengthen muscles and improve balance, that you’ll need afterwards.
3 Lose weight if you’re overweight – it makes surgery and recovery much easier.
4 If you smoke, stop – to reduce your risk of chest infections and other complications.
5 Buy an apron with pockets so that your mobile phone and other essentials are always to hand.