If you make knee replacement devices for a living, a surefire way to increase your market share and grow your company is to target your ads for this highly invasive procedure (joint amputation and insertion of prosthesis) to younger people with arthritis. That’s exactly what the big boys who make these devices have been doing. They show people with knee replacements running, biking, mountain climbing, you name it. The problem is that these ads are having an impact, but not in a good way. Let me explain.
What We Already Know About the Problems with Knee and Hip Replacements
In the world of orthopedics, one thing that seemed to come with the turn of the new millennium was more aggressive marketing tactics. Device manufacturers (those who produce artificial knees and hips) have led the pack here with ad campaigns leading arthritis sufferers to envision a return to the full activities of their youth…and all it takes is replacing that painful old joint with a shiny new artificial one. If you believe this, then I have some land to sell you cheap; the deeds are in my trunk…
I’ve probably written enough on knee and hip replacements on this blog over the years to fill up a book, so I’m just going to review a handful here, but following the links will allow you to dig deeper into the topic if you’d like to learn more. Let’s start with some of the outcomes and risks of knee replacement.
Don’t expect the fairy-tale return to full activity seen in the ads. Many studies have shown otherwise with one finding that 5% or less of knee replacement patients achieved anything even close to a normal return to activity. The most common complaint following knee replacement is chronic pain, which is disturbing when you consider the fact that pain is the primary reason patients ultimately give for getting the surgery in the first place. According to one study, 34% of knee replacements are medically inappropriate. Why? Because they are based on incidental X-ray and MRI findings, and your knee pain could actually be due to a problem in your low back (which means replacing your knee isn’t really going to help). Additional well-known knee replacement risks include heart attack, blood clots, and stroke.
Studies have also highlighted another very disturbing fact: younger patients getting knee replacements. And now a new study shines another bright light on age and other demographic trends…
Demographic Trends in Knee and Hip Replacements
Using the US National Inpatient database, the new study looked at trends in the demographics (sex, race, and age) of patients who underwent total knee and hip replacements and revisions over a 15-year period (2000–2014). The results? There has been a progressive and significant decrease in the average age of patients who are getting hip and knee replacements. In 2000, the average age for hip replacements was 66.3, while in 2015 this had dropped to 64.9. For knee replacements, in 2000 the average age was 68; in 2015, the average age for a knee replacement was 65.9.
While these decreases in age may seem mild, it’s the patients in their 40s and 50s who are pulling these averages south. In 2000, it was unheard of for a forty- or fifty-something to get a knee replacement. The problem is that these younger patients just don’t do as well. Let’s take a look at that data.
The Disturbing Trend of Knee and Hip Replacements in Younger Patients
On the surface, it seems logical that younger patients would handle surgery and healing better than older patients; however, with joint replacement, this isn’t the case. In fact, the younger you are when you undergo knee replacement, the more likely your new knee will fail! Why? Younger patients are more active and expect a lot more from their new knee. For older patients, active may mean walking a couple of laps around the block after a knee or hip replacement. For younger patients, active may mean running, hiking, or even participating in a sport after a knee or hip replacement.
Pain also seems to be a bigger issue for younger patients with knee replacements when compared to older patients. Though the older patients typically have more severe arthritis, it’s the younger patients who experience more pain after surgery, which could be attributed, again, to higher activity levels in younger patients. Also, while these younger patients expect to get up to 15 years from their knee replacement before a revision is necessary, the reality is that within five years, 15% have already undergone revision.
The upshot? The ads focused on people in their 40s and 50s have sparked a grand new public health experiment. What happens when you get your first knee replacement at 45? If you’re active, you’ll likely need your second knee by 55. The problem then becomes, is there enough bone left for the third prostheses at 65? If so, then it’s unlikely that a fourth surgery is possible. These are the patients I have begun to see in the office. They have been painted into a proverbial cycle of continuous invasive surgery and they have fewer and fewer options as they age. My description above doesn’t even account for complications. One patient I saw the other day had prostheses loosening at an early age and had a second and then third procedure. There is no fourth procedure possible for this guy, and the knee is still painful and warm, indicating some sort of tissue reaction or chronic infection. What can this guy do? Not much…These are the problems we’re creating by pushing people to get their knees replaced younger and younger.