Total joint arthroplasty in younger patients. Is there trouble on the horizon?


In the Lancet, Bayliss and colleagues now introduce the use of lifetime risk as a novel approach to illustrate the risk of revision surgery following joint replacement [1]. Wim Schreurs and Gerjon Hannink from the Department of Orthopedics, Radboudumc, were invited by The Lancet to comment [2] on Bayliss and colleagues’ paper.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are safe and effective surgical procedures for advanced degenerative osteoarthritis. The lifetime risk of revision (LTRR) for patients over 70 years of age, most of the arthroplasty patient population, is low (5%). However, for patients aged 50–54 years, LTRR increases up to 35%. What makes the situation even worse is the trend, partly driven by patient request, to perform THA and TKA in ever younger patients. The current trend to implant total hip and knee implants in ever younger patients, driven by the fact that the short-term outcomes in the first few years after surgery are mostly acceptable, could lead to many patients ceasing to be revisable, and these patients might become a large burden to society in terms of cost and disability. Both patients and surgeons need to be aware of this possibility, and postponing this kind of surgery, despite the realistic limitations of patients with osteoarthritis, should be considered more frequently.

1. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.Lancet. 2017 Feb 13. 

2.Total joint arthroplasty in younger patients: heading for trouble? Lancet. 2017 Feb 13


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