Total hip replacement for young arthritis patients? Not so fast…
Total hip replacement (THP) is, in many cases, a good thing. I know, because I’ve had one hip replaced and it improved my quality of life tremendously. However, I had that replacement 35 years after it might have happened under different circumstances. And I am glad I was able to hold off.
I mention this because recently I read an article wherein hip replacement for juvenile arthritis is being put forward as a best option. The paper was presented by a surgical center, so the recommendations need to be put into perspective. There are pros and cons to THP for the young, and I’d like to examine a few here.
Total hip replacement
Total hip replacement is a major surgical procedure. The original and damaged joint, socket and cartilage are surgically cut and removed from the femur (thigh bone) and hip.
The hip joint is known as a ball and socket, where the ball (or femoral head, round top of the thigh bone) fits nicely into the socket (cupped shape in hip opening) and motion is smooth. When arthritis sets in, over time it changes the joint and bone integrity and structures, causing pain, inflammation and shortened range of motion.
A surgical procedure removes the diseased ball and socket, replacing them with a titanium prosthesis, ceramic head and plastic socket.
Total hip replacement is usually reserved for the elderly, though in recent years replacement in adults in their 40s has increased greatly. It is believed that this is because of the “extreme” nature of modern sports and athletic activities without proper warm up, rest and self-care.
It is best to hold off on THP as long as one is able, because more need to be replaced again after 10 years. What’s more, because of infection risk and risk of permanent damage to the surgical site, it is only safe to do a total of three replacements in a lifetime.
Which brings us to the notion that THP is the “best option” for juvenile arthritic patients…
Replace the hip at 12 … what happens at 42?
One in 150 American children suffers juvenile arthritis. JA is a term used to group the various autoimmune disorders affecting children 16 and under. While JA affects the joints, it also can affect the eyes, skin and gastrointestinal (GI) tract as well.
JA, while similar to rheumatoid arthritis (RA), is more easily diagnosed. As a parent or guardian, if a child under your custody or watch complains of or presents swelling in one or more joints for a period of at least six weeks, this may indicate that they have JA.
A paper featured on Science Daily, touted THP as “an excellent option for patients under age 35 when conservative treatments fail to provide pain relief… The implant lasted at least 10 years in 85 percent of patients.”
This leads to the problem of doing the first THP on patients as young as 12 years old.
For the study, researchers collected data on 56 patients with juvenile arthritis. Of these, 41 had undergone bi-lateral THP (both hips replaced) and 15 had only one hip replaced. Based on these results, senior researcher Mark Figgie, MD concluded, “Joint replacement can free patients from a life of unrelenting pain. It can enable those in a wheel chair to walk again. Patients can go back to school or work and get their lives back.”
In a vacuum, maybe.
Pros and cons of replacing joints early
There were a total of 97 individual hips replaced in the study, which were followed up over 12 year periods. During this time researchers found that those patients under age 25 were more likely to need a second hip replacement sooner than those over 25 years.
They weren’t sure why… but I’m sure you’re astute enough to have come up with the answer already. Younger people are more physically active and less careful with their bodies than older people. And the more active and rougher one is on their joints, the more stress, physical load, wear and tear is placed on them, and replacements need to happen.
The problem with hip replacements is that they don’t last long. So patients are often told to wait and try other options. Plus, with each surgery there is risk of infection and greater side effect. And with current technology it is only safe to replace a hip three times. One THP and two revisions for worn-out parts.
When a 12 year old gets THP and needs revision at age 22 and again at age 32… what is he/she to do from age 42 onward? Unless procedures and replacement materials improve, they will likely be wheelchair bound by middle age.
This is not good, by any standard.
I have been suffering chronic migraine headaches and musculoskeletal pain nearly my entire life. And when it comes to low back pain, hip pain and groin pain, I am the king of pain. At about the age of 10, the ball joint of my hip joint slipped moderately off its growth plate. The technical term is slipped capital femoral epiphysis (SCFE; pronounced skiffy).
At that age, if they had found the issue via x-rays (which they didn’t) I could have had surgery to places pins in to hold the femoral head in place.
I didn’t and as a result, I did extreme self-care for 35 years, including stretching, massage and bodywork therapies, acupuncture, chiropractic, topical pain-relieving gels, Chinese and Western herbal medicines, energy medicine, yoga, and Pilates.
Toward the end of that time, the pain was so severs I actually consented to steroid hop injection. The first one worked wonders to reduce pain by 80%. The two follow-ups in three month intervals made the problem so much worse, I suffered avascular necrosis of the femoral head. That basically means the blood supply to the hip ball joint was stunted and the alive parts died and the head collapsed. As such, it finally became time to replace the hip, and the direct anterior approach to total hip replacement had good results. You can read my full story in an article I wrote here.
I still have not had the right hip replaced, as I am able to delay the procedure with self-care. Fingers crossed I can keep it this way for another decade!
Delay the replacement
My point is, while the paper of the aforementioned study does support good results with THP. Yes, THP can instantly decrease pain levels and help restore range of motion and quality of life. Once the hip is totally replaced, there ceases to be any arthritis in the joint.
So the young boys and girls and teens and young adults with JA are able to find quick relief and regain their life.
But at what price?
The researchers say to do THP when other options have failed. But have they really offered all the options?
My primary care physician was against alternative medicine, supplements, chiropractic and acupuncture. So I took it upon myself to look into them early on. Later, building my studies and career around them.
But many don’t know these methods are viable options. I wrote a book on natural methods to treat arthritis called Arthritis Reversed, featuring a very well-developed self-care program that anyone can follow. It’s the program that helped me stave off THP for three and a half decades, and it’s all things anyone can do.
Getting hip replacement is a last options. Yes, it improved pain levels and quality of life, but you pay for it with a poor life quality in a wheelchair at midlife or later life, if you’ve had the first replacement too soon.
Do yourself a favor, and please do your child a favor, and first exhaust all the natural and modern methods for controlling pain, inflammation, range of motion, immunity, and the psychological challenges that go along with these first, and for as long as you can.
Take the long view, not the quick fix. Make sure you’re making an informed decision, given the outcomes of limited replacement and repeat surgery options.