January 9, 2023 – When she was 12 years old, Daniela Banus de Veer fell from a balcony in her native Venezuela, shattering her femur. After an advanced operation that involved the insertion of pins and plates, she was in a position to carry on along with her life and even qualify for the Olympic swimming trials in 2000. But Banus de Veer was still aware that she probably had little time left before getting hip substitute surgery.
After Banus de Veer lost blood supply to the top of her femur following the accident, her doctors advised her to attend so long as possible for hip surgery. That's exactly what she did, until Banus de Veer ended up limping and holding her femur. She was in pain with every step. Her quality of life was affected day-after-day, and so on the age of 32, Banus de Veer began on the lookout for surgeons.
Eventually she found one and had the surgery. The results were simply incredible, she says.
“Two hours after the procedure, I was able to get up and walk around without pain,” she says. “I had two sessions of physical therapy in the hospital and went home the next day.”
Banus de Veer represents a trend: joint substitute is an increasingly viable option for a younger population. According to a study published in 2018 on the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), the typical age for primary total hip substitute surgery has dropped from 66.3 years to 64.9 years and for knee substitute surgery from 68 years to 65.9 years. Another study A better take a look at discharge rates after total joint substitute surgery showed that this rate increased dramatically amongst younger patients (defined as 45 to 64 yr olds).
This trend is influenced by quite a few aspects. For one, the substitute parts themselves have improved tremendously, allowing for a for much longer lifespan. Another reason is that individuals are more lively in organized sports from a young age and proceed to play sports or other types of exercise later in life. Today's 50-year-olds are typically a more lively version of their parents. Joint wear and tear increases through the years, eventually resulting in an inability to take part in the activities they enjoy.
Overall, joint substitute operations at the moment are being performed increasingly incessantly on younger and younger patients.
The parts and processes
When Banus de Veer injured her hip 25 years ago, doctors advised her to attend until the pain became unbearable to have a hip substitute. Back then, hip replacements might provide relief for 15 years before a second substitute was needed. But because of advances within the prostheses themselves and improved surgical techniques, that is not any longer the case. Today's substitute joints can last as long as 25 years in some cases.
Robert Murrah, MD, an orthopedic surgeon at Orlando Health in Florida, has been performing hip and knee substitute surgery for 30 years and has watched the procedures evolve.
“Hand in hand with a better understanding of materials and techniques, the training of surgeons has also evolved, so that today they are much more precise and equipped with many more instruments,” he says. “The result is better surgical outcomes and a longer lifespan of the equipment.”
William Leone, MD, director of the Leone Center for Orthopedic Care at Holy Cross Health in Fort Lauderdale, FL, agrees.
“The method I use today to repair the hip soft tissues, including the hip joint capsule, is much more robust than in the past,” he says. “Today, knee replacement techniques result in less injury to muscle groups, resulting in a faster return to function.”
Murrah says that in younger, fitter patients, a more moderen alternative surgical approach to the front of the hip is way less invasive than traditional approaches.
“There is less soft tissue injury and a faster return to function,” he explains. “The traditional approach is the posterior side, which is much more extensive and heals more slowly. This is still the most common approach, but in patients who are suitable for the new technique, recovery is much better.”
The materials are also higher. Leone says subtle refinements to the form of the implants have led to more precise restoration of joint movement and stability.
“Improved wear properties of the plastics used for hip prostheses, for example, have reduced the risk of postoperative hip dislocation,” he explains. “The development of dual-mobility bearings that move in two planes further improves stability and reduces the risk of dislocation.”
Improvements in instrumentation have also contributed to the longevity and quality of the outcomes, says Leone.
“Surgical instruments have been redesigned to allow for minimally invasive procedures,” he says. “In addition, robots, computers and sophisticated sensors are being used to enable patients to recover more quickly and return to full activity.”
If you're one in every of the younger patients considering joint substitute, Murrah has a number of tricks to show you how to have the most effective experience possible: “If you're a smoker or overweight, try to lose weight and quit smoking before the procedure,” he recommends. “This will lead to better results.”
And when considering where and who should perform your procedure, “choose your surgeon based on their training, experience, years of practice and the number of cases they have performed,” he advises. “Don't choose the procedure, choose the surgeon.”
Banus de Veer never looked back after her hip surgery, and at her last five-year check-up, her latest joint looked just nearly as good because it did immediately after surgery. She now runs several times every week and has recovered “her whole life,” she says.
“If I had known that my first step after surgery would feel so good, I might have done it sooner.”