As I’ve said before, the single biggest growth area in knee replacements has been younger and more active patients. You see ads on buses, on billboards, in the newspaper, and on TV ads where young and active people are climbing mountains or running with their “brand-new” knee. The problem with that business model is reality. Here’s yet another study that shows that younger and more active people don’t increase physical activity because of their knee replacement. That only happens in older and less-active patients.
The new study recorded baseline activity levels as well as patients’ expectations prior to knee replacement to treat osteoarthritis. Patients were assigned one of two baseline (presurgery) activity levels: active or inactive.These baselines were compared to activity levels at two years after surgery, and patients were followed for ten years. Interestingly, nearly 70% of the active patients expected to reclaim their normal activity levels following surgery, while 55% of the inactive patients expected this.
The results? Only 27% of the active patients exceeded their baseline (presurgery) activity levels, while nearly 70% of the inactive patients exceeded their baseline. In addition, the active patients were more likely to have to undergo revision surgeries (3.2%) when compared to the inactive patients (1.6%).
So while the majority of the younger and more active patients are expecting the types of activity levels those flashy ads promise after knee replacement, very few are actually experiencing it. Additionally, for active patients, especially those few who are able to achieve normal activity levels after the surgery, the unfortunate result of the effect of all of that activity on the artificial knee may be early revision surgery. How early? One study found that 15% of younger knee replacement patients will require revision surgery within five yearsdespite the fact that most are under the impression that their artificial knee device will last for 10 to 15 years.
What about those inactive patients? They certainly aren’t experiencing the unrealistic activity levels shown in the ads either; however, when a patient with severe arthritis (e.g. bone-on-bone arthritis) goes from being mostly immobile (presurgery baseline inactivity) to being able to walk around the block (after surgery), this exceeds many inactive patients’ expectations.
There are three key expectations most patients have when they pull the trigger on a knee replacement. One, as we’ve already mentioned, is an increase in activity. Two is the relief of pain. And three is an improvement in function. So if younger and more active patients aren’t experiencing an increase in activity levels, are they at least benefitting from the other two? Unfortunately, none of these are realistic outcomes! Let’s review some of the many problems younger and more active patients are experiencing following knee replacement:
The upshot? I chuckle a bit when I see the ads on the buses in my hyperactive town of Boulder Colorado that show knee replacement patients climbing mountains. While I’m sure that there are some that do, just due to sheer will and determination, I know that most don’t get back there. This has always been one of the reasons we treat so many doctors, nurses, and other healthcare providers with our highly advanced stem cell procedures. At the end of the day, they’ve “been to the puppet show and seen the strings”. Meaning, they have seen the patients who don’t do well and when their own knee wears out, they’re not signing up for a knee replacement without a fight.
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