Total hip replacements in the United States have been rising, especially among adults in early middle age, and surgeons say even people in their 20s and 30s are having these procedures more often.
Athletic, strong and conditioned, Remick, 24 years old, keeps up with her father and brother working in her full-time job. Remick drives a tractor to pull a cultivator and prepare the ground for planting, changing hydraulic lines and tires on large farm implements – she works full-time on the family’s farm.
Two years ago, she had a total hip replacement. Before the surgery, her hip hurt throughout high school and beyond graduation, but even so, Remick jumped into college basketball. She thought she could play through the pain and deal with it, but the pain that especially affected her at night was getting the best of her. Some nights she’d only get two or three hours of sleep.
Finally, she went to an Iowa City doctor who referred her to orthopedic surgeon John Clohisy and her problem found a solution.
On February 2015, the U.S. National Center for Health Statistics analyzed hospital data on total hip replacements from 2000 to 2010. The number of surgeries doubled to about 310,000 by the end of the decade. Procedures rose by 92% in people aged 75 and older, and they increased by 205% in people between the ages of 45 and 54.
Clohisy says “In general, total hip arthroplasty is being performed in younger patients,” and adds “For a teenager, a bad hip can be very disabling and really restrict their quality of life”.
The decision to perform a total hip replacement on a young person is not made lightly. If it is possible, surgeons opt for alternative procedures.
Orthopedic surgeons may suggest a technique called the Bernese periacetabular osteotomy, which involves cutting the bones around the hip socket and repositioning them. This can be a good choice for young patients with certain hip conditions, such as hip dysplasia and hip impingement, which involves an abnormal contact or abutment between the socket and femur.
Candidates for hip-preservation procedures may be showing signs of cartilage tears and possibly early arthritis.
The hip-preservation procedure tends to have a slightly longer recovery than the joint replacement. The difference is probably t one to two months, as the bone heals. After a joint replacement, patients can place their full weight on their hip right away.
But hip-preservation has some advantages over the alternative. If it is done on a healthy natural hip joint and surgeons can preserve and reconstruct the hip, it is not going to get dislocated or get infected. With the right hip reconstruction, patients can enjoy very high activity levels.
This surgical choice is clear-cut sometimes, for example, an 18-year-old patient with a dysplasia and no arthritis is an excellent candidate.
With the materials now used in implants and refined surgical techniques, a surgeon’s reluctance to do a total hip replacement on someone in their 30s or 40s is not as strong as it used to be.
A lot of patients have been tremendously helped by contemporary hip replacement procedures.
For Remick, who was in her early 20s, the reconstructive surgery option seemed likely at first, but her exam results changed the discussion.
Remick had to go through four weeks of physical therapy to make sure that her muscles healed.
Most surgeons opt for reducing their patient’s activities after a total hip replacement, but Remick continued with her horse shows and heavy lifting on the farm and she seemed to have no regrets about the surgery. Even if it means that she will eventually need another total hip replacement, she doesn’t mind, as long as she can still enjoy what she likes to do.