Orthopedic surgeons weigh in on joint care
Patient pool for knee replacements is getting younger.
Scripps Howard News Service
Whether you're a weekend warrior or physically worn out by the end of the week, the aches and pains in the lower extremities catch up with millions of Americans every year.
Some of the top minds and hands at repairing the damage met recently in New Orleans to share what they know about hips, knees, ankles and replacement parts.
Army medical researchers reported to the American Academy of Orthopedic Surgeons what they found after studying four years of ankle sprains that were severe enough to bring the sufferer to an emergency room.
Dr. Brian Waterman and his colleagues showed that ankle sprains are likely to occur among the young (10 to 19 years of age) and athletic — almost half of the injuries come during athletic activity, mostly during basketball games.
But the really notable differences are between the sexes. Pre-teen and early teen girls are at greater risk than boys the same age, but from 15 to 24, the guys have higher rates of sprains. Then, after age 30, women are at greater risk of sprains than men.
Waterman said more research is needed to be sure of the reasons behind the differences, but suspects they are a complex combination of girls and boys developing at a different pace, different levels of sports activity between the genders in young adulthood and differences in balance, hormones and other factors that might increase ankle-injury risk for women later in life.
Because many soldiers are in the high-risk groups and suffer so many sprains on duty, Waterman and his colleagues have also been investigating better ways to prevent the injuries — braces and wraps being one approach. He also noted that special exercise programs to strengthen ankle ligaments have proved helpful in military experiments.
Moving up to the knee, researchers reported the results from several studies showing that almost all patients in a five-year sample of more than 6,000 were satisfied with the results of knee-replacement surgery a year later, and that of those who were taking narcotic pain medication before the operation, 85 percent were able to cease taking the drugs afterward.
Dr. David Ayers, a professor at the University of Massachusetts Medical School who worked on both studies, said the fact that so many patients were able to stop pain meds "is a big success. And we couldn't tell from the data whether the patients that continued to take narcotics were taking it for their knee or some other problem that the knee surgery may not have helped."
The less than 5 percent of patients who were not satisfied with their knee replacement tended to be younger, more active people who may have had overly high expectations of how much utility they might recover, Ayers said.
Another study, by a team from the Mayo Clinic, noted that younger patients are the growth pool for knee replacements.
Hospital-discharge data collected by the U.S. Centers for Disease Control and Prevention show that about 800,000 patients had knee replacements between 1990 and 1994, compared with 2.1 million in 2002 to 2006.
The average age of the patients fell two years, from 70 to 68, during the two time periods.
"We're going to be seeing younger patients undergoing this procedure, but we may also see more failures and more revisions, and physicians and medical facilities need to prepare for that," said Dr. Michele D'Apuzzo, a Mayo resident who led the study.
There is some evidence that surgical procedures may need to be different for younger versus older bones. For instance, a Finnish study of hip replacements done in patients 55 and younger found that joint implants that don't use surgical cement were significantly less likely to have to be fixed over the next 15 years.
Another study, done by researchers at the Hospital for Special Surgery in New York City, studied a small group of knee- or hip-replacement patients and found that 53 percent of the patients had higher expectations for their function after surgery than did their doctors, underscoring a need for better communication and education.
Still other research on knee-replacement patients found that taking part in high-impact sports like aerobics, basketball, soccer and jogging were no more likely to have their artificial joint fail than those who did not take part in such sports.
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