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The New Face of Total Knee Replacement
What if I told you that image has changed drastically in the last decade? The amount of knee replacements for any age has skyrocketed, 120%, in the last ten years according to the Arthritis Foundation but even more interesting is that they report a 188% increase in people having replacements between the ages of 45 and 64 years of age. Comparatively there is only an 89% increase in those ages 65-84 years old (1).

Some Good News
Knee Replacement for a Younger Population: There are many good reasons impacting the need for younger people to have their knees replaced. According to the Cleveland Clinic’s website, total knee joint implants had an anticipated life of 10 years in the 1970s but in recent years 85% of implants are lasting 25 years (2). So now, a patient in their 50s may get a replacement and it will be sufficient throughout their lifetime, instead of anticipating at least 2 more replacements or revisions. The Arthritis Foundation even cites revisions as being a “pro” when debating whether to wait for a replacement because revisions are becoming easier. The implant can be switched out instead of removing more bone, like during the original surgery.
CNN and AARP reasoned that adults are participating in high intensity activities beyond just high school and college which creates a larger population of people with arthritis developing after injuries (2&3). Further, patients are realizing that they can continue to be active after a replacement and are expecting to not have to give up what they enjoy. Patients after joint replacements want to, and often do, go back to playing pickleball, golf, hiking, cycling, dancing, and other competitive sports.

New Face of Knee Replacement
The CNN data also shows that over the years surgeons are more positive that surgery outcomes will be good for a patient, who can get more use out of their replacement at a younger age, before having other health issues (2). This assurance is likely because of how common the operation has become and high success rates. In younger patients undergoing knee replacements the success rate is between 90-95%, states the Arthritis Foundation (1).
Boxing After Knee Replacement

Some Bad News
Unfortunately, as optimistic as it is to think that only active lifestyles and scientific improvements have caused a shift to younger TKA candidates, one mutually agreed upon reason remains – rising obesity. A study in the Journal of Bone and Joint Surgery supports this and it is cited as a common cause leading to a TKA in articles on the Cleveland Clinic and CNN webpages as well as many other websites discussing knee joint replacements. As weight rises throughout the population joint replacements are sought out sooner.
Obesity Rates in United States by Age

Age, Obesity and Knee Replacement
According to the study referenced by the American Academy of Orthopedic Surgeons, obesity has risen faster in those aged 18-64 years of age, compared with their over 65 year old counterparts (4). The study compares what influenced changes in the recent rise in hip and knee replacements. Both types of joint replacements experienced similar changes in reimbursement, hospital stays, and physicians. The outstanding difference was weight gain, therefore, it was clear that obesity was driving factor in the increase of young TKA patients.
How do you Decide if it is Time for Surgery?
If you are a younger person considering a knee replacement how do you decide if it’s the right time for you? Of course, a honest conversation with an orthopedic surgeon is important, as well as other health care providers. But the Arthritis Foundation offers a good set of pros and cons to consider on your own (5):
Pros (in favor of knee replacement):

You will have decreased (or no) pain!

There is a 90-95% success rate in younger patients

Revisions may be needed but don’t require removal of more bone in most cases
Stay active in what you enjoy
You are less likely to negatively effect your hip and back because of knee issues
Cons (in opposition to knee replacement):
Recovery requires time, money and a solid commitment
A younger replacement means more wear on the prosthesis which can lead to damage requiring a revision or another replacement

Surgery comes with risks

You may be able to return to most, but not all, of your favorite activities, with some limitations on high impact activities
So the question for many is, “Should I just go forward and have the surgery based on my pain level, activity pattern and lifestyle needs, or wait it out? In Part Two of this two part series we examine what activities you can return to after knee replacement surgery and how your expectations for life after surgery should be examined closely before entering an operating room.