Is obesity the reason why total joint replacements are needed at younger ages?

Related articles

Since 2010 the University of Massachusetts Department of Orthopedics and Physical Rehabilitation has been maintaining a national database (FORCE-TJR) of total joint replacement surgical and patient-reported outcomes of the surgery. The research effort collects data from the practices of 120 orthopedic surgeons and 30,000 of their patients. Their website states Arthritis is a significant public health issue, with 60 million U.S. adults diagnosed with osteoarthritis, a degenerative condition of joint connective tissue, making it the leading cause of disability in adults.

Recently, a disturbing trend has been observed in the data from this study. As reported in The New York Times, the population of adults opting for total knee replacement surgery to ameliorate the pain and limited mobility of osteoarthritis has been younger than previously noted: While the number of annual knee replacements has doubled in the last decade, the number in people under age 65 has nearly tripled.

Suggested reasons for the trend included baby boomers trying to remain active, as well as overly aggressive marketing of knee replacement surgery. But the most likely reason, according to data from FORCE-TJR is obesity: 55 percent of patients under 65 were obese, compared with 43 percent of those who were 65 or older. And about 11 percent of those younger patients were in the severely obese category defined as a BMI greater than 40. In contrast, only 5 percent of the older group was that obese. Further, these younger patients had the same degree of pain and disability as the older group, undermining the theory that they were simply trying to maintain an active lifestyle.

Massively obese patients present more of a challenge to surgeons, as they may have other health conditions such as diabetes and poor circulation, which may require special instruments and larger implants.

ACSH s Dr. Gilbert Ross, a rheumatologist, notes: These data suggest more burdens for the health care system in the future. Knee replacements do not last forever, thus these younger patients may well be facing at least one more such surgery down the road.