Submitted by Thomas Pereles, MD, Shenandoah Valley Orthopedics & Sports Medicine
It may astonish the reader that the number of THAs done yearly in the U.S. jumped from 140,000 in 2000, to 310,000 in 2010 (CDC, National Hospital Discharge Survey). Additionally, a 2007 study projected that the number of THAs (total hip arthroplasties) would increase by 174% by 2030, and a 2014 study reaffirmed that projection. No less astonishing than that is the fact that during that same time period the percentage of those procedures done on patients under the age of 55 jumped from 12% to 17%. Clearly THA is a procedure done not just on grandparents.
And why shouldn’t younger patients enjoy the benefits of less pain and an improved activity level? The development of highly cross-linked polyethylene (poly) and improved processing methods to reduce oxidation-related poly wear over time have allowed for expected longevity of THA to exceed the expected lifespan of most THA recipients. Additionally, the use of ceramic rather than metallic femoral heads to articulate against the poly socket bearing material is expected to further improve wear resistance.
As THA materials have improved, so have surgical technique and rehabilitation protocols following the procedure. Because of this, length of recovery has improved greatly in the 21st century. Hospitalization following THA averaged about three days in the first decade of the new millennium. Now, the expected hospitalization following THA at Augusta Health is little more than 24 hours, with most patients able to ambulate, with a walker, the length of a football field prior to discharge. Additionally, less than ten percent of patients require a skilled-care stay prior to returning home.
The activities in which one can expect to participate in following THA has also expanded. While most patients are encouraged to participate exclusively in low-impact aerobic exercise (e.g. walking, cycling, swimming, golf and doubles-tennis), occasionally orthopedic surgeons allow patients to participate in more rigorous exercise, including jogging, singles-tennis, basketball and soccer. At Augusta Health, THA has been performed on patients as young as twenty-three years of age and on those whose occupations include collegiate athletic trainer, active-duty police officer and teaching tennis professional.
Lastly, the expected longevity of implants has greatly improved since the 1990’s. In 1995, it was considered rare for a THA to function well beyond fifteen to twenty years. In contrast, today the expected failure rate for THA is less than one percent per year. In other words, a patient can expect a greater than ninety percent chance that the implant will last at least ten years and a greater than eighty percent chance that it will last more than twenty years. With performance data like that, it is no wonder that younger patients are now beneficiaries of the improved pain and return to an active lifestyle that modern THA provides!