Dillsburg woman's hip replacement at 62 common as patients for procedure get younger
By Carolyn Kimmel Special to PennLive
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An original complaint of pain in her knees sent Dillsburg resident Marj Strayer on a two-year journey to orthopedic doctors, rheumatologists, a chiropractor, an acupuncturist, a spine surgeon and physical therapists before the culprit for her woes was identified - worn-out hips.
"An MRI on my knees early on didn't show anything so I moved on to the OIP"This generation is unwilling to accept the expectation that previous generations had that pain and slowing down comes with aging,'' says Dr. William Polacheck.
Orthopedic Institute of Pennsylvania rheumatologist, who diagnosed me with fibromyalgia," said Strayer, who was not convinced of that diagnosis. "The pain was worsening and moving to my lower back. At one point, I couldn't even push a grocery cart and I was in a wheelchair to shop."
Through water therapy, cortisone injections and acupuncture, Strayer kept an open mind, hoping for relief.
Finally, a rheumatologist watched how she walked and told Strayer it looked like she had osteoarthritis. The doctor ordered a hip x-ray, which confirmed the diagnosis.
Strayer had no cartilage left between her ball-and-socket joint; it was bone rubbing on bone. She needed both hips replaced, which she did in early 2013, six weeks apart.
At age 62, Strayer was relatively young to have a hip replacement, but new government statistics show even younger patients than Strayer are having hip replacements by the thousands.
The big surprise was how the number jumped by 205 percent in those ages 45 to 54, to 51,900.
"The main cause of hip replacements is osteoarthritis; the hip joints just wear out," said Dr Ronald Lippe, chairman of orthopedics at Pinnacle Health in Harrisburg and a doctor at Orthopedic INstitute of Pennsylvania in Camp Hill. "It usually starts out slow, but we haven't found a treatment to help stop the progression."
Osteoarthritis, which doctors say is becoming more common, is initially treated with anti-inflammatory drugs, physical therapy and a cortisone shot to offer temporary relief.
"A hip replacement is an elective procedure. We replace the hip when patients say they have had enough pain," Lippe said. Although it is elective, the surgery - which involves replacing the head of the femur, or thigh bone, and its socket - is covered by insurance.
While the increase in osteoarthritis accounts for some of the increase in hip replacements, doctors say another reason is that people are simply more active these days and not willing to accept a lower quality of life.
"This generation is unwilling to accept the expectation that previous generations had that pain and slowing down comes with aging," said Dr. William Polacheck, chief of orthopedics at Holy Spirit Hospital and a doctor at Orthopedic Institute of Pennsylvania.
Osteoarthritis can also be genetic. Strayer's mother had two hip replacements when she was a little older than Strayer is now.America's escalating obesity rates could also be contributing to the spike in hip replacements. "We do know that increased weight leads to increased arthritis," Lippe said.
Vast improvements in the hip replacement procedure have also undoubtedly made people more apt to opt for it.
"Forty years ago it was still considered a risky endeavor. In general the satisfaction rate with hip replacements is about 97 percent and I don't think we have any other operation that can beat that," Polacheck said.
The first "total hip replacement" surgery dates back to the early 1960s. However, it was still a pretty rare procedure until the late 1980s, when the number of cases grew from an estimated 9,000 in 1984 to 119,000 in 1990, according the NCHS report.
"It's the best operation in the world. We take people who have pain and disability and restore their lives," Lippe said.
The components of the replacement have also improved, making them sturdier and more functional, Polacheck said.
Earlier types of plastic would shed microscopic debris that would get into the bone and loosen the components as the body tried to absorb them, Polacheck said. With the stronger plastic used today, there is much less absorption.
Also, whereas the components used to be cemented together, now they have a better surface that allows the bone to grow into them without using the cement.
The improvements in hip replacements that have worked suggest that the hip replacements put in today, even on middle-aged people, may last the rest of their lives, doctors said.
"Early data is very encouraging. These replacements show very little change on x-ray after five to seven years. Does this mean they will last 40 years? We don't know but it seems very possible," Polacheck said. "Many people believe the hips we are putting in now will last the patient's lifetime in a majority of cases," Lippe agreed.
Although hip replacements have made tremendous improvements, one attempt failed - the idea that all metal replacement parts would be superior to metal-on-plastic, doctors said."In the U.S., just about all of these have been recalled. The past 10 years in hip replacements have been marred by this failed innovation," Polacheck said. "The theory was that less debris would be generated with metal, but the problem is that there is still microscopic debris and it's particles of metal like chrome and cobalt, which can be very toxic to the surrounding tissues."
Strayer's knee pain was gone immediately after surgery and she was back to her normal routine in less than a month, she said.
"Right after the surgery, it was very painful to try to move or get up, but I was able to go a few steps before I left the hospital," said Strayer, who was home in three days.
She was vigilant about doing her prescribed exercises that involved swinging her legs out and back and then up and down.
Even pain-free patients should get regular x-rays every couple of years for the rest of their lives; however, Polacheck worries that the new trend toward high-deductible insurances will discourage people from doing it.
"If you're at home saying, 'I played golf today and I feel great; I'm not going to pay for an x-ray,' that's a risky option," Polacheck said.
Pain would be a sign of wear, but an x-ray could show wear before it causes pain, he said.
Today, Strayer says she doesn't even think about the fact that she has artificial hips.
"It's not something to be afraid of; I thought the whole thing was amazing," she said. "Find out everything you can about the surgery beforehand so that you know what to expect. That will make you more confident."