Knee reconstruction in young patients
Dear Mayo Clinic: I am 35 and have had various knee problems for a few years now. I am a runner and play other sports. My primary care doctor said I would eventually need a knee replacement. Am I Too Young to Replace a Knee?
Answer: There is no easy answer to whether or not knee replacement is ideal for younger patients. While there is no strict age cutoff in knee replacement, several interventions short of knee replacement can reduce pain, including nonsurgical and surgical measures.
Non-surgical measures include anti-inflammatory drugs and potentially narcotics; modified activity; the use of an assistive device, such as a cane, crutches or walker; injection into and around the affected knee; and physical therapy for strengthening, gait training and range of motion.
Surgical options are also available for some people to restore or repair the damaged cartilage and ligaments in the knee. Orthopedic surgeons perform these procedures, and these options are often reserved for people who have specific cartilage and ligamentous injury patterns.
A conversation with an orthopedic surgeon can help determine whether a patient is a surgical candidate for a traditional knee replacement or elective procedure. The decision to proceed with knee replacement is usually based on several factors, including the condition of the cartilage of the knee or the severity of the arthritis, ligament injury, the patient’s physical age, and the patient’s activity level.
Some surgeons use new techniques in knee replacements that seem to improve outcomes. Among these advances is the use of computer navigation – both the robotic and non-robotic types – to aid in accuracy, as well as products that do not require cement to bind to bone, or which may be referred to as cementless total knee replacements. known in.
Several studies have evaluated these progressions in younger patients undergoing knee replacement.
One study showed excellent results in young patients with both computer navigation and manual total knee arthroplasty techniques, but no benefit of computer navigation in terms of function, pain, and survival.
A recently published study showed that in young patients with total knee arthroplasty, both the cementless and cementless designs had excellent survival, with a 97% survival at 25 years in the cementless group and reoperation for any reason. The Cement group had 98% at the time of assessment.
Another publication evaluating this topic showed better results in pain scores when using cementless knee replacements in younger patients, but no difference in function or complications.
Another common question asked by younger patients seeking knee replacement is how long the replacement will last. Again, various studies have evaluated the “survival” of knee replacements in younger patients, as well as what happens if there are replacement issues. The results of one study indicated that functional improvement and implant survival in patients under 55 years of age undergoing total knee replacement were between 90% and 99% at 10 years and 85% to 97% at 20 years of follow-up. was in Similarly, partial knee replacement in patients younger than 50 years of age was shown in another publication to have a significant improvement in function, with 96% at six years and 86% of implants at 10 years.
What research has revealed, however, is that a small percentage of patients will require further knee surgery or a revision knee replacement. A study comparing patients 55 and younger to an older population showed that younger patients required further surgery, particularly surgery for infections and extensor system failures, which often occur in the quadriceps muscle and Tendon, affects the patella and patellar tendon.
Depending on your activity level, your goals for your lifestyle, the condition of the knee cartilage and the amount of knee pain, an orthopedic surgeon to review and discuss care and treatment options for joint replacement for young patients An evaluation should be sought with the surgeon. While surgery may be optimal for an individual, it may be best to pursue nonsurgical options before going in for a knee replacement. –Corey Couch MD, orthopedic surgery, Mayo Clinic, Rochester, Minnesota
(Mayo Clinic Q&A is an educational resource and does not replace routine medical care. E-mail MayoClinicQ&[email protected] a question. For more information, visit www.mayoclinic.org.)
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