Am I Too Old for Joint Replacement?

Factors That May or May Not Affect Your Eligibility

Consulting with doctor
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Joint replacement surgery is a common treatment for severe osteoarthritis. Hip replacement and knee replacement are the most frequently performed of these surgeries and are most often done in people between the ages of 55 and 80.

There has long been a popular conceit that older age automatically excludes people over 80 from joint replacement surgery due to everything from anesthesia complications to the fragility of older bones.

But is any of this true, or are there ages when having a joint replacement is unadvised?

Factors Considered by Surgeons

As a rule, age alone is never a contradiction for any surgery, including a joint replacement. Doctors are far more interested in the overall health of an individual rather than the chronological age. Because of this, a younger person might be considered unfit for certain operations, while an elderly person may breeze through the evaluation without a problem.

When performing an eligibility assessment, an orthopedic surgeon will focus on three key things:

  • Your current health status is the primary criteria for inclusion. This not only involves a physical examination, blood tests, and imaging scans but a review of your medical history and any acute or chronic health conditions you may have.
  • Your physical strength will also need to be evaluated to ensure you can undergo the rehabilitation process. In order to do this, the doctor will need to see if the patient has the strength lift himself or herself, use a walker or other mobility device, and fully participate in physical therapy,
  • Your cognitive function will also be evaluated to ensure you have the capacity to see the process through and prevent any harm to yourself and your implant. This is especially important for hip replacement surgery where special precautions are needed to protect the hip.

Factors That May Exclude You

While age alone won't exclude you from surgery, other factors—including some aging-related factors—may.

Among some of the more common red flags that surgeons watch out for:

  • Severe osteoporosis may make it impossible to perform the surgery because the bones may be too brittle to support the new joint prosthetic. While mild to moderate osteoporosis is not a contraindication, it may affect how a surgeon performs the surgery.
  • An existing infection can also exclude you from surgery, at least until such time as the infection is fully healed.
  • Cigarettes won't outright exclude you but may factor in if you are on the borderline for eligibility. Research suggests, among other things, that smokers are10 times more likely to need a revision surgery than a non-smoker.
  • Obesity is also not a direct contraindication but may factor into your assessment. If your weight makes it impossible you to lift yourself, for example, you may not have the means to adequately participate in physical therapy.
  • Alcoholism, substance abuse, or mental illness can also make it difficult for a surgeon to sign off unless there is some form of established treatment to ensure you'll adhere to rehabilitation and avoid falls.

Strangely enough, the one aging-related factor that may make you ineligible is younger age. Because joint prostheses have a limited lifespan, doctors will often delay surgery for younger people for as long as possible to ensure that the joint can stay put for the rest of that person's life.

Things You Need to Consider

If you are older and believe that you need a joint replacement, take the time to consider whether now is the right time and you are willing to commit fully your post-operative rehabilitation. Start by asking yourself a few, simple questions:

  • Is your pain severely impacting your quality of life and keeping you from doing everyday tasks such as shopping, driving, or cleaning the house?
  • Does the pain prevent you from getting enough sleep at night or interfere with your ability to walk, stand, sit, or navigate stairs?
  • If you smoke, are you willing to quit to improve your rehabilitation?
  • Are you willing to seek treatment if you are alcoholic or have a substance abuse problem (including prescription drug abuse)?
  • Are you willing to exercise and lose weight, if needed, to better ensure your recovery?
  • Do you have someone who can assist you during rehabilitation or the means to access the necessary nursing home or home health care services?

If you answer "no" to any other these questions, speak with your doctor and have a heart-to-heart about whether a joint replacement is the right option or if there are other avenues of treatment you can explore.

Sources:

Chang, B.; Yoo, J.; Koh, I. et al. "Key factors in determining the surgical timing of total knee arthroplasty in osteoarthritic patients: age, radiographic severity, and symptomatic severity." J Orthop Traumatol. 2010; 11(1):21-27; DOI: 10.1007/s10195-010-0086-y.

Hamel, M.; Toth, M.; and Legedza, A. "Joint Replacement Surgery in Elderly Patients With Severe Osteoarthritis of the Hip or Knee." Arch Intern Med. 2008; 168(13):1430-40; DOI:10.1001/archinte.168.13.1430.

Singh, J. "Smoking and Outcomes After Knee and Hip Arthroplasty: A Systematic Review." J Rheumatol. 2011; 38(9):1824-34; DOI: 10.3899/jrheum.101221.

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