Am I Too Young
for a Hip or Knee
Replacement?

0:00 · Introduction to the topic

Hi, I'm Dr Chien-Wen Liew. Today, we're going to talk a little bit about your hip and knee replacement as a younger person. I'm an orthopaedic surgeon specialising in hip and knee replacements, and I work at Orthopaedics 360. for a knee replacement is a fantastic operation. And if you've read or listened to any of our materials so far, you'll know. Part of the decision making algorithm for when you should have a hip or knee replacement.

0:36 · Age and decision factors

But obviously, what it comes down to is, are you too young? And that is a question that many of our younger patients in their 30s, 40s and 50s ask. Traditionally, many years ago, we used to really aim for our patients to be above 60 years old. Current literature probably looks and supports patients who are over 55 years old. Of having only one joint replacement, that will most likely last their whole life.

In general, there's a one in 10 chance of acquiring a revision to that joint replacement within the first 20 years, as found on the Australian National Joint Registry. And that is changing every year now. Part of the decision algorithm about whether or not to have a joint replacement often doesn't relate specifically to age. And once we have determined that, you actually warrant a joint replacement. Due to your quality of life impairment,

your maximization or optimisation of your non-operative management, and your overall discomfort with daily activities, then we can opt to look at a joint replacement,

1:46 · Optimization before surgery

even if you're on the younger side now, despite your age. If you are struggling with your hip or knee. And you've optimised everything. Such as physiotherapy, baseline medications, weight loss and all of the other modalities that you can try, then there is no reason not to consider a joint replacement. We don't need to get you to a specific age where you might find that you're on heavy pain medication.

Using a lot of walking aids such as wheelchairs, or unable to maintain the muscle mass around the joint due to immobility. Because that will end up with a poor result as well. So our decision to perform a joint replacement, although we consider age as something that's very important and to ensure that you're not too young to perform the surgery. We certainly don't use it as our only tool. And once you have optimised the non-operative measures, then we do look at performing a joint replacement. Despite your age,

2:43 · Longevity and techniques

the main question that people ask are, how long will this last? And the cohort of patients who are in their 30s and 40s is actually very small. And our literature, although it supports the fact that you will require a revision, or most likely require a revision later on in life. Current methods and techniques allow us to perform those revisions with a lot less damage to the soft tissue and with a lot less risk profile as they were before.

For example, with the direct anterior approach for hip replacements that I perform, we actually access the hip without cutting or detaching any of the muscles or tendons to access the joint. This is very different to the operation that I was performing over 10 years ago. Where we used to have to split the gluteus maximus on the back and then detach the four short external rotators from the bone at the back.

This is called the posterior approach and is an excellent approach to the hip. However, has a limitation that further revision operations down the track still require detaching of those same elements. Often we find that things like the dislocation risk is significantly higher for patients with revision operations. This is most likely because we're detaching those structures again for the second time. And they may not heal back in the same way that they healed in the first time.

With the direct anterior approach, we feel that we can access the hip in the same way that we did the first time, without cutting or detaching any muscle. Now, typically, speaking in current hip replacements and knee replacements. Implant materials have improved considerably over time. So the catastrophic revisions that used to occur decades ago probably no longer will occur in the future.

And we're not seeing a lot of them come through the system now, as a lot of them have been dealt with over the last decade.

4:39 · Expectations and limitations

So when we go to what you can do and can't do after the surgery. I think it's important for our younger patients to go through the expectations of what a hip and knee replacement can do for you, whilst we know that a hip and knee replacement will reduce the discomfort that you have in the joint, will allow you to function in a much higher level. It still will not allow you to perform certain activities, such as long distance road running.

We have dealt with that in a separate video, so you can check that out by visiting our channel. If you do want to run, it is probably not a good thing to embark upon a hip or knee replacement for that reason alone. If your sole goal is to remove pain, to walk as far as you want to, and to perform all of the normal activities like hiking, cycling, swimming, kayaking, snow skiing and things like that,

then absolutely, a hip or knee replacement is going to restore those functions. But high performance activities like long distance road running, sprinting on the road, high impact sports and jumping off high objects is something that a hip or knee replacement is not designed for. So, the majority of the counseling that we do with our younger patients is about setting the expectations of what you should be looking for after the joint replacement operation itself.

I hope that's gone to answer a few of the questions that you may have as a young person looking to have a joint replacement surgery. Any more information that you need, follow us on this channel. Or I'll catch up with you in the next one. Thank you.

Transcript edited lightly for readability.