TRAG­I­CALLY HIP

What hap­pens when you need a joint re­place­ment decades ahead of the typ­i­cal 60-ish age of en­ti­tle­ment? The short an­swer: Not much. Many doc­tors are re­luc­tant to per­form this surgery on women in their 30s or 40s, even when it’s their only chance at a norma

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By her 30s, Ruth Goudie was

limp­ing with what felt like granny hips, hurt­ing all day, ev­ery day. Some­times it was a deep, throb­bing ache; other times, like her bones grind­ing to­gether. “When you’re in that much pain for a long pe­riod, it ru­ins your life,” says the Toronto-based pub­lic re­la­tions di­rec­tor, now 43. “It’s so dam­ag­ing men­tally and phys­i­cally.”

Once her pre­scrip­tion painkillers stopped of­fer­ing re­lief — even at max dosage — she knew what she wanted: a to­tal hip re­place­ment. But when she went to a sur­geon at age 39, he shut that idea down. “He was rude and dis­mis­sive,” she re­calls. “He said, ‘You’re too young. Come back when you’re crawl­ing.’”

In Canada, joint re­place­ment surg­eries are in­creas­ingly in de­mand. Over the span of a decade (from 2004/5 to 2014/15), the num­ber of hip re­place­ments done an­nu­ally has more than dou­bled and knee re­place­ments have increased by 83 per­cent, ac­cord­ing to the Cana­dian Joint Re­place­ment Reg­istry. “There are two broad rea­sons why: our ag­ing pop­u­la­tion and obe­sity,” ex­plains Dr. Eric Bohm, an ortho­pe­dic sur­geon at the Con­cor­dia Joint Re­place­ment Group and pro­fes­sor of surgery at the Univer­sity of Man­i­toba, point­ing to the most com­mon risk fac­tors for joint dam­age.

Though less com­mon, there are women like Goudie who don’t neatly fit the typ­i­cal pa­tient pro­file. In 2014/15, women un­der 45 ac­counted for about one to two per­cent of knee and hip re­place­ments, re­spec­tively. And when you’re young, the ex­pe­ri­ence can come with ex­tra chal­lenges, in­clud­ing fac­ing un­will­ing sur­geons, cop­ing with ma­jor surgery while balanc­ing fam­ily and chas­ing ca­reer goals, and ac­cept­ing the risk of need­ing more op­er­a­tions one day (re­vi­sions if the new joint loosens or the plastic parts wear out).

For Goudie, her hip or­deal dated all the way back to her early 20s when she took pred­nisone (a cor­ti­cos­teroid) for a mere two weeks to treat her asthma. She could never have pre­dicted that a rare side ef­fect would cause os­teonecro­sis — death of bone tis­sue in the joints due to in­ter­rupted blood flow.

In her 20s, she un­der­went a fibu­lar bone graft (trans­plant­ing tis­sue) to re­lieve the har­row­ing pain, but Goudie knew it wasn’t a per­ma­nent fix. And the risks of get­ting a to­tal hip re­place­ment weren’t enough to scare her off. So when she was told she was “too young,” she was shocked and dis­ap­pointed — but un­de­terred. She sought out the doc­tor who had done her ear­lier bone graft­ing. He agreed to re­fer her for surgery; Goudie got her new hip at 40.

Re­luc­tance to re­place joints on younger pa­tients comes from “old think­ing,” ex­plains Dr. Ja­son Werle, clin­i­cal as­so­ci­ate pro­fes­sor at the Cum­ming School of Medicine, Univer­sity of Cal­gary. “His­tor­i­cally, we were wor­ried about how long the im­plants would last.” Pre­vi­ously, they were es­ti­mated to go only 15-20 years be­fore need­ing re­place­ment. But to­day, Dr. Werle says, most doc­tors un­der­stand that peo­ple don’t want to post­pone qual­ity of life, so if con­ser­va­tive treat­ments such as hyaluronic acid in­jec­tions (for joint pain re­lief ) don’t help, then surgery is an op­tion even for the rel­a­tively young.

The ma­te­ri­als used for joint re­place­ments have also vastly im­proved. “[Now] I tell pa­tients that im­plants could last 25-30 years or more,” says Dr. Werle, though he cau­tions their true life span re­mains to be seen, since the lat­est tech­nol­ogy isn’t yet old enough to have out­come sta­tis­tics for that du­ra­tion.

As an ex­am­ple of su­pe­rior tech, Dr. Werle points to cross-linked poly­eth­yl­ene, a type of plastic now used to line the socket in to­tal hip re­place­ments (see the “Cut­ting Edge” side­bar). “This new-gen­er­a­tion plastic wears out 90 per­cent less than the plastic used prior to 2000,” ex­plains Dr. Werle, not­ing that this has led to a de­cline in re­vi­sion surg­eries be­ing needed. “We’re hop­ing this makes [the im­plants] last longer de­spite us do­ing surg­eries on younger pa­tients.”

For Goudie, her new hip was life-chang­ing. She woke up from surgery with 52 stitches, but that same af­ter­noon, she was up and mov­ing with a walker. Re­hab was gru­elling — “they’ve cut through mus­cle and you have scar tis­sue” — but she knew she had to work for her re­cov­ery. When she wasn’t at physio ap­point­ments (three times a week), she was at the pool walk­ing back and forth. To her sur­geon’s sur­prise, she was able to walk into her six-week checkup with­out crutches.

Th­ese days, Goudie is pain-free and even did her first ever 5K last sum­mer. She ac­cepts there’s a risk of need­ing a re­vi­sion surgery in the fu­ture and she’s OK with that. Some­times she for­gets that a piece of ti­ta­nium is a part of her body. Her mes­sage for those go­ing through an ex­pe­ri­ence like hers: “Any­one who’s feel­ing like I felt, don’t wait. Don’t give up when the first per­son says no. You re­ally have to self-ad­vo­cate.”

For An­drea Claire, an ed­i­to­rial

makeup artist/hair­styl­ist from Toronto, now based in Sin­ga­pore, be­ing her own health ad­vo­cate meant trust­ing her in­tu­ition when she sus­pected she had been mis­di­ag­nosed — ul­ti­mately, see­ing seven dif­fer­ent ortho­pe­dic sur­geons in a pro­longed quest to un­der­stand the cause of her pain.

In 2008, when she was 36, Claire was bit­ten by a mosquito in Sin­ga­pore car­ry­ing the chikun­gunya virus. The high fever went away, but she never fully re­cov­ered. She was plagued by per­sis­tent joint aches and pains, par­tic-

ularly in the hips. “I felt like, some­thing’s not right,” she says. But her doc­tors didn’t agree on what (one di­ag­nosed os­teonecro­sis; an­other, a blood dis­or­der re­quir­ing thin­ners), or whether she should have her hips re­placed or just rest.

An aunt’s friend was an ortho­pe­dic surgery pro­fes­sor in Min­neapo­lis, so in 2012, Claire f lew there for yet an­other opin­ion — one last-ditch ef­fort to solve her med­i­cal mys­tery — and more test­ing, re­do­ing MRI scans and blood work. It cost $27,000 all told, but was worth it: Claire didn’t have a blood dis­or­der, and if she had con­tin­ued tak­ing thin­ners, they could have killed her.

What Claire did have: re­ac­tive arthri­tis lead­ing to hip de­gen­er­a­tion, trig­gered by that years-ago bug bite. Most of her pain was caused by labral tears (dam­aged car­ti­lage around the hip socket). Claire went through surgery in an at­tempt to stitch up one tear, but it didn’t work. A year later, she was limp­ing. Her fam­ily had to move from their house to a condo be­cause Claire couldn’t climb stairs with­out help. At 43, she wanted a to­tal hip re­place­ment, but doc­tors pre­ferred to de­lay. “It was frus­trat­ing,” she says. “Why should I wait un­til I’m 60 or 70?”

Claire pushed for the pro­ce­dure and also went look­ing for sup­port on­line — specif­i­cally, younger pa­tients like her. She also be­gan chron­i­cling her “med­i­cal drama” on her blog. Those around her only talked about hip re­place­ments as a se­niors’ surgery, and she couldn’t re­late. “I know peo­ple are try­ing to help by say­ing great-great­grandma had it done and was plant­ing petu­nias in no time, but that is not help­ful to me,” she wrote.

What did help was so­cial me­dia. “I started hash­tag­ging some In­sta­gram posts with #hipreplace­ment, and it was amaz­ing to see how the com­mu­nity came out,” says Claire. “I found a bunch of women in my age cat­e­gory and younger.” That’s how she came across fel­low Cana­dian Goudie — an ocean away, but by co­in­ci­dence, get­ting a new hip at the same time. They kept in touch, shar­ing mes­sages of sup­port pre- and post-op.

Af­ter surgery, Claire didn’t feel better right away — in fact, she was de­pressed. Re­hab was painful, she couldn’t do the job she loved, and she felt isolated. It took sev­eral months be­fore the post-op­er­a­tive de­pres­sion lifted.

De­spite the chal­leng­ing pe­ri­ods, Claire doesn’t hes­i­tate when asked if the surgery was ul­ti­mately worth it, and just re­cov­ered from her sec­ond hip re­place­ment, jok­ing that she’s now bionic. “Any time I meet any­body who says they’re hav­ing hip is­sues and they might need a hip re­place­ment, I al­ways tell them, when you get to the point where you want to do it, do it.”

Tamara Ko­mu­niecki has lived

with pain for as long as she can re­mem­ber. The Van­cou­ver­based pro­pri­etor of Del­ish Gen­eral Store was only six when she was di­ag­nosed with ju­ve­nile rheuma­toid arthri­tis, an au­toim­mune dis­or­der in which the im­mune sys­tem at­tacks the body, caus­ing joint swelling, pain and dam­age. Now 46,

she’s al­ready un­der­gone 14 arthri­tis-re­lated surg­eries. “My goal is to be all metal. It would be great to get that adaman­tium like Lo­gan [X-Men’s Wolver­ine],” she quips.

In her twen­ties, she had her first joint re­place­ments, for the knuck­les in her big toes. The re­lief was im­me­di­ate. Af­ter that, her surg­eries were mainly for small joints — wrists, an­kles, thumbs — un­til Ko­mu­niecki gave birth to her son seven years ago. The im­pact of be­ing an ac­tive mom and car­ry­ing him around was a tip­ping point, ac­cel­er­at­ing the toll of her arthri­tis, es­pe­cially on her hips and shoul­ders.

Thus, she faced the prospect of more surgery. “There was no doubt — I couldn’t go on the way I was,” she says. “The sur­geon in­formed me that I might need to have [my hip] re­placed again if I had prob­lems with it later, but there was no way that was go­ing to hold me back.”

She had a hip re­placed in 2013, fol­lowed by a shoul­der in 2015.

There will be, in­evitably, more surg­eries to come for Ko­mu­niecki, since rheuma­toid arthri­tis is a pro­gres­sive dis­ease. “It’s a steadily, slowly mov­ing train,” she says. “Even­tu­ally, all of th­ese joints will be de­stroyed, and there will be no al­ter­na­tive to cut­ting them out and putting in new ones,” she says.

De­spite all this, Ko­mu­niecki stays re­mark­ably up­beat in her out­look, choos­ing to fo­cus on her bless­ings, like her fam­ily, and her abil­ity to pour en­ergy into her work, which in­cludes an up­com­ing book on her health story.

She’s in­tent on be­ing as healthy as pos­si­ble for as long as pos­si­ble. So she swims, bikes, does yoga and Pi­lates, and re­cently took up jog­ging. “I felt com­pelled to run one day and my son was al­most in tears, clap­ping and run­ning be­side me, say­ing, ‘Momma, you can do it!’” re­calls Ko­mu­niecki. “It was so amaz­ing and I felt so good af­ter. And you know what, there’s no rea­son I can’t do it.”

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