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The People Getting New Knees and Hips in Their 40s
The population of patients under 65 getting joint replacements grew by about 200% over the past two decades
By Alex Janin, WSJ
Aug. 20, 2024 9:00 pm ET
The average age of hip- and knee-replacement patients is getting younger.
As average life expectancy ticks up, many Americans are no longer willing to sacrifice decades doing their favorite activities, such as skiing, hiking or playing pickleball, to sit in pain, doctors say. And staying sporty into your 50s and 60s is good for your physical and mental health.
Certain intense, high-impact fitness activities can increase the chances of injury and arthritis—leading to more procedures.
“In the past, people would just say, ‘I don’t run, I have bad knees,’” says Dr. Ran Schwarzkopf, an orthopedic surgeon at NYU Langone. Now, he says, “they’re not willing to accept limitations that arthritis gives.”
The other reason younger people are getting replacements is the growing prevalence of obesity in the U.S. More than 40% of U.S. adults have obesity, the Centers for Disease Control and Prevention says, up from roughly 30% in 1999. Excess weight puts more pressure on the joints—roughly 4 pounds for each additional pound of body weight—leading more patients to need replacements earlier in life.
For patients ages 45 to 64, there was a 211% increase in inpatient hip replacements and a 240% increase in inpatient knee replacements between 2000 and 2017, according to data from the U.S. Department of Health and Human Services’s Agency for Healthcare Research and Quality. (Records after 2017 are less accurate due to changes in Medicare coding.)
There was also an increase in joint replacements for patients ages 65 to 84, but the rise wasn’t as steep.
This tracking doesn’t include the growing share of replacements that are outpatient surgeries, which allow patients to go home the same day as their procedure. More than a million hip and knee replacement surgeries are performed in the U.S. every year.
‘You’re young for this’
The procedures involve replacing damaged or worn-out bone and cartilage in your hip or knee joint with prosthetic implants. Plastics have improved, which has helped replacement joints last longer on average, so surgeons are generally less wary of performing them on younger patients.
“Back in the day, patients were told they had to wait until they were 70 or 80 to undergo this procedure because implants did not last long enough,” says Dr. Antonia Chen, an orthopedic surgeon at Brigham and Women’s Hospital. “Now, implants last 20, 25 or 30 years, and quality of life means a lot more.”
Chen estimates that patients under 65 account for roughly 50% of her practice now, up from roughly 30% in 2014.
The procedures are more efficient now, helped by robotic assistance and custom-fitting 3-D-printed prosthetics. And advances in physical therapy, anesthesia and the administration of pain medicine have led to shorter patient recovery times.
Many patients who would have spent days to weeks in a hospital bed are now encouraged to walk the same day.
Carol Pope knows that, at age 37, she isn’t what most people picture when they think of hip replacements.
“The two things I’ve heard most is, ‘Wow, you’re young for this,’ and, ‘My grandma’s hip surgery went great!’” she says.
Pope, a personal-finance writer and avid runner based in Lakeland, Fla., first felt a twinge of pain along her back and legs at the starting line of a half marathon race in January. She finished the race without incident but the pain returned and spread. A doctor diagnosed her with osteoarthritis and told her she would have to stop running.
Losing her favorite hobby was like grieving a death, she says. Her hope was renewed when an orthopedic surgeon agreed to schedule a hip replacement for September.
“I’m just looking forward to getting it done so I can get my life back,” says Pope.
Not a preventive measure
Dr. Kevin Stone, an orthopedic surgeon at the Stone Clinic in San Francisco, encourages patients to exercise after recovering from surgery. Author of a book called “Play Forever”—about how people with injuries and arthritis can keep moving—he says the more activity, the better.
“Our goal is to have people drop dead at age 100 playing the sport they love,” says Stone.
Many still recommend minimizing or altogether avoiding running and other high-impact exercises after surgery, because it can put extra pressure on the prosthetics. Our joints are like tires, surgeons say. The more weight the tire carries, the quicker it wears out.
These procedures are largely elective, and surgeons caution they still shouldn’t be considered preventive. They carry risks including infection, dislocation or joint instability. Doctors generally agree that surgery makes sense when the pain is chronic and limiting, affecting everyday decisions. For example, if you notice yourself looking for an elevator for one flight of stairs, or you decide against a vacation plan for fear of pain, it may be time.
Before surgeons can recommend the surgery—often a requirement of insurance coverage—patients need to show they attempted other possible solutions, such as physical therapy, weight loss and cortisone injections.
Younger patients often assume they’ll have faster, smoother recoveries. Yet surgeons say active people can be more likely to push themselves too far during recovery. In addition, they can strain the new joint more over time and have more years to wear it out. Some research suggests younger patients are more likely to need a repeat surgery later on.
Dave Erickson, a gym owner in Sparta, Wis., was hopeful that the hip replacements he got at age 46 would enable him to return to his normal exercise routine and last for decades. Just five years after his surgery, however, a bike accident landed him back in the operating room, undergoing a revision to his right prosthesis.
He lost a significant range of motion in his right leg, and though he still works out, he avoids certain exercises like weighted squats and lunges.
“When you’re old and you can barely walk, and now you can walk, it’s an improvement,” says Erickson, now 54. “When you’re squatting in the gym and running and then get a hip replacement and you can’t do it anymore, that’s not so great.”
Write to Alex Janin at alex.janin@wsj.com
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