Joint Replacement Surgery - Are You Too Young?

Are the Results Worth the Risk?

Doctor looking at knee replacement x-ray.
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Joint replacement surgery, often regarded as a "last resort" treatment, can provide tremendous pain relief for patients suffering with severe arthritis. While joint replacement surgery has a high success rate, especially of the hips and knees, the fact that it is major surgery should not be overlooked.

Joint replacement involves the removal of cartilage from both sides of a joint and the insertion of a prosthesis (the new joint prosthesis is made of metal or metal and plastic components).

Simply put, an orthopedic surgeon removes the damaged joint and replaces it with an artificial one.

The hierarchy of treatment plans for arthritis suggests that more simple and conservative steps be tried and exhausted before surgery is ever considered. Conservative treatments that may be tried, include:

Even by the time surgery is presented as a treatment option, a physician may choose more simple procedures, such as synovectomy (removal of synovium) before joint replacement.

As treatments are chosen, the intent is to get the most successful outcome for managing arthritis with the most conservative approach possible. Though joint replacements are viewed as successful, they are also viewed as mechanical parts with a limited lifespan. When joint replacement surgery is indicated, the goals are to:

  • achieve pain relief
  • regain function
  • correct deformity
  • prevent further damage

Younger People With Arthritis

In the Journal of Bone and Joint Surgery (2003;85A:1090-1094), researchers from the Mayo Clinic in Rochester, Minnesota reported excellent results from knee replacement surgery in children and teens with juvenile rheumatoid arthritis, in terms of pain relief and improved function.

Thirteen young patients were followed for an average of 11 years post-op. Prior to surgery, two of the 13 said they could not walk. The others walked indoors only or for short distance outdoors. At the end of the follow-up period, six patients reported they could walk more than six blocks. One patient remained wheelchair-bound. Researchers added that 4 of the young patients had to undergo additional surgery though and many experienced complications of surgery.

The limited lifespan of the prostheses suggest that revision surgeries will be necessary in the future to correct for their failure. Each subsequent surgery is more complicated than the preceding procedure. The realization that younger patients will require more revisions leads some doctors to dissuade their patients. In the case of younger arthritis patients, the benefits and risks of surgery must be carefully deliberated.


The Duke University Medical Center Book of Arthritis proposes that the following questions be considered by any person deciding on surgery:

Pain Level

Is your pain unacceptable? Constant pain that does not respond to other treatment, keeps you awake at night, and interferes with work or activities is severe enough to require surgery.


Do you require narcotic pain relievers? If you require daily medications at full allowable dosage to control pain, surgery may be indicated.

Pain Management

Have you tried all other options to achieve pain relief? If the use of arthritis medications, physical therapy, rest, exercise, joint protection, remittive agents, and steroid injections has yielded unsatisfactory results, surgery may be a valid choice.


Are you prepared to conscientiously follow a rehabilitative regimen? You must be psychologically prepared for months of exercises and physical therapy to restore joint function following joint replacement surgery.

Physical Condition / Realistic Goals

Are you in good physical condition? Risk of complications will be low if your overall physical condition is good. Are your goals realistic? The rehabilitation process and the expected outcome of the surgery must be viewed realistically. Joint replacement surgery is not a cure, but it should offer restored comfort and function.

Risks Vs. Quality Of Life

Some patients end up in wheelchairs as they wait to become old enough to be considered a candidate for joint replacement surgery. Surgery may be delayed by some doctors because of anticipated complications. Yet, the opposite perspective is held by other doctors who recognize that the severity of the disease and loss of function warrant the surgery regardless of age. It becomes a quality of life issue with the benefit of enhanced quality of life weighed against potential risk. Advancements in the design of joint prostheses are leading to better long-term results, which may ultimately solve the dilemma.


Journal of Bone and Joint Surgery, 2003;85A:1090-1094

The Duke University Medical Center Book Of Arthritis, David S. Pisetsky, M.D., Ph.D., 1992

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