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
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.”