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Age hardly matters in joint replacement

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Dr Ramneek Mahajan
With poor and sedentary lifestyle catching up among the younger and middle-aged population, increasing health ailments are also prevailing. Osteoarthritis is the second most common rheumatologic problem and is the most frequent joint disease with a prevalence of around 40% in India.
It is the form of arthritis which features the breakdown and eventual loss of cartilage of one or more joints. Cartilage is shock absorbing substance which acts as cushion in between the joints. Although osteoarthritis can affect any joint, this disorder commonly affects hands, knees, hips and spine.
With recent advancements in the treatment module for arthritic knee pain, minimally invasive techniques such as partial knee replacements (button Surgery) come as a boon especially among the middle-aged population. The disease is associated with modifiable and non-modifiable risk factors such as obesity, lack of exercise, bone density, occupational injury. The physical ability arising from pain and loss of functional capacity reduces the quality of life and increases the risk of further morbidity. This condition is three times more prevalent in women as compared to men, which ultimately leads to joint replacement surgeries.
Partial knee replacement is a very successful procedure for arthritics where the disease is confined to the medial or the lateral compartment of the knee. The most significant factor to note is that osteoarthritis always starts in medial compartment of knee and partial knee replacement is a procedure to reverse the disease process and realign it to the pre disease state, thereby providing natural function.
The latest techniques like partial knee replacement are proving much better than previous ones, ensuring a long-lasting positive effect on knees. Earlier knee replacement was considered a necessity for the elderly suffering from the persistent pain. But today with improved implant technology and technique, the present generation is positive towards opting for surgery at an earlier age.
Incidences of Joint replacement surgeries have seen an upsurge in the past 5 years. According to the recent data provided by Joint registry (ISHKS), over 35,000 total knee replacements (TKR) have been performed in India in the last 5 years. It is evident from the data that more than 75% of the TKR were performed on women ranging in the age bracket of 45-70 years. More than 33000 cases (over 97%) of TKR were attributed to osteoarthritis.
Since osteoarthritis is caused by cumulative effect over a period of time, age is one of the major factors for the joint damage leading to osteoarthritis. With increasing age, one is highly susceptible to repetitive episodes of stress on the joints, while other causes may include past injuries, like torn cartilage, dislocated joints, or ligament injuries, joint malformation, infection, obesity, poor postures.
One of the biggest unanswered questions remain is the ideal age to undergo joint replacement. While a common notion is that usually people prefer to undergo such surgeries after the age of 55 years, but this does not mean to keep the young patients (under 40 years) to continue to suffer significant pain due to arthritis.
Inflammatory arthritis such as rheumatoid arthritis can damage the joint at a relatively young age and cause serious disability. This may need a knee replacement at an early age. In younger patients generally Simpler technically demanding procedures like cartilage regeneration surgeries are done with the help of keyhole made into the joint and cartilage harvested and grown in the lab. Other methods like use of viscosupplements or blood derived product like PRP or with life style modification or by doing physiotherapy we can delay the replacement in younger patients.
But age is not only a factor that can decide the time of replacement, clinical and radiology examination of joint by qualified Orthopaedics surgeon is the main key for deciding the timing of replacement surgery. It can happen in younger age or may not be needed after 70 years of age so it’s all depends on the severity of disease so regular visits to orthopaedic surgeon and health check-up followed by clinical and radiological assessment is gold standard for deciding the timing of replacement.
(The author is Senior Director (Orthopaedics) & Head Joint Reconstruction (Hip & Knee) Unit, Max Hospital, Saket)

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