DEAR MAYO CLINIC: I am 35 and have had various knee issues for a few years. I’m a runner and played other sports. My primary care physician said I would need a knee replacement eventually. Am I too young for a knee replacement?
ANSWER: Whether or not knee replacement is ideal for younger patients is not a simple yes or no answer. While knee replacement has no strict age cutoffs, multiple interventions short of knee replacement can reduce pain, including nonsurgical and surgical measures.
Nonsurgical measures include anti-inflammatory medications and potentially narcotics; modified activity; use of an assistive device, such as a cane, crutch or walker; injections in and around the affected knee; and physical therapy for strengthening, gait training and range of motion.
Surgical options for restoring or repairing damaged cartilage and ligaments in the knee also are available for certain people. Orthopedic surgeons perform these procedures, and these options often are reserved for people who have specific cartilage and ligamentous injury patterns.
Having a conversation with an orthopedic surgeon can help determine if a patient is a surgical candidate for a traditional knee replacement or an alternative procedure. The decision to proceed with knee replacement is usually based on multiple factors, including the condition of the knee cartilage or severity of arthritis, ligament injury, a patient’s physiologic age, and the patient’s activity level.
Some surgeons use new technologies in knee replacement that seem to improve outcomes. Among these advances is the use of computer navigation — both robotic and nonrobotic types — to aid in precision, as well as products that do not require cement to bind them to bone, or what’s known as a cementless total knee replacement.
Several studies have evaluated these advances in young patients undergoing knee replacement.
One study showed excellent outcomes in young patients with both computer navigation and manual total knee arthroplasty techniques, but no benefit of computer navigation in terms of function, pain and survivorship.
A recently published study showed that in young patients with total knee arthroplasty, both cemented and cementless designs had excellent survivorship, with 97% survivorship at 25 years in the cementless group and 98% in the cemented group when evaluating for reoperation for any reason.
Another publication evaluating this topic showed superior outcomes in pain scores when using cementless knee replacement in younger patients but no difference in function or complications.
Another common question by young patients seeking knee replacement is how long the replacement will last. Again, various studies have evaluated the “survivorship” of knee replacement in young patients, as well as what happens if the replacement has issues. Results in one study indicated that patients younger than 55 years undergoing total knee replacement had functional improvement and implant survivorship between 90% and 99% at 10 years and 85% to 97% at 20 years of follow-up. Similarly, partial knee replacement in patients younger than 50 was shown in another publication to significantly improve function, with implant survival of 96% at six years and 86% at 10 years.
However, what research has revealed is that a small percentage of patients will need further knee surgery or a revision knee replacement. A study comparing patients 55 and younger to an older population showed that younger patients are twice as likely to need further surgery, particularly surgery for infection and extensor mechanism failures, which often affect the quadriceps muscle and tendon, the patella, and the patellar tendon.
Depending on your activity level, your goals for your lifestyle, the state of the knee cartilage and the amount of knee pain, young patients should seek an evaluation with an orthopedic surgeon to review and discuss care and treatment options for joint replacement. While surgery might be optimal for one person, it may be best to pursue nonsurgical options first before moving to a knee replacement. — Dr. Cory Couch, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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