Young and hipless: that mid-life marathon is ruining your bones
More younger people are having hip replacements, says the writer, who had hers done at 48
I am standing in a gym, holding on to the wall. “Point your right toe in front of you!” shouts the instructor. “Now, move back and point your left toe in front of you!” It reminds me of my Irish dancing classes when I was 10, only now I’m 48, and in a physiotherapy class while I await a hip replacement.
If you’re thinking I sound a little young for a new hip, well, so did I. But the number of hip replacements on people under 60 has risen 76% in the past decade. Indeed, a record number of joint replacements were carried out in 2018 and, while most involved people between 60 and 80, doctors are seeing a growing trend for joint replacements in younger patients.
Ninety percent of joint replacements are carried out to treat osteoarthritis – when the protective cartilage at the ends of the bones wears away, causing friction and pain as bones begin to rub together. The key drivers of osteoarthritis are age, genetics and injury to joints. But some experts believe our new appetite for exercise, with middle-aged men and women training for events such as marathons and triathlons, may be playing a role in the growing numbers of younger people having replacement hips, knees and shoulders.
“Some people are more susceptible to developing degenerative joint conditions due to family history, or an injury they sustained in early life,” says Jeremy Latham, an orthopaedic surgeon at Southampton University Hospital and the Spire Group. “If they then take up a high-impact sport, it can accelerate damage so that their joints – particularly the knees, in the case of running – wear out more quickly.”
Professional careers also take an early toll: Andy Murray had hip resurfacing surgery in January, aged just 31, in a final attempt to save his tennis career after years of pain. The procedure, which involves covering the top of the femur joint with a metal cap, is an alternative to full hip replacement surgery.
Physiotherapist Adam Royffe says he sees rising numbers of younger patients with osteoarthritis in his clinics – “many people who have taken part in a lot of sports throughout their lives, played a lot of football, done a lot of running or a lot of impact sports”. Indeed, when I was diagnosed with osteoarthritis at 44, after pain and clicking in my right hip, I was surprised to be asked how much rugby I’d played as a teenager. I hadn’t played any, but my consultant thought it could be linked to the Irish dancing I’d done as a teen, practising for up to six hours a day for big competitions – along with family history (my mother has had arthritis since her 20s and had a hip replacement in her 50s). An X-ray confirmed osteoarthritis and a bony bulge on my hip, which was removed later that year.
But three months after the operation I was still in pain, unable to put all my weight on my hip and using a crutch. Nine months later, my surgeon said a hip replacement was the only option. He advised me that huge advances had made artificial joints much longer-lasting, with superior movement, but I was still horrified and began to read up on alternatives. I began taking glucosamine and rosehip supplements – thought to reduce pain by reducing inflammation – and within six weeks I was walking without crutches. But despite three years’ respite, my osteoarthritis wasn’t going to go away, and in the summer of 2016, while out walking, a familiar pain shot down my right leg. I was back on a crutch for a year and a half and I realised this was it.
I joined the waiting list for a hip replacement, eventually having to take regular painkillers as my hip slowly disintegrated. I had surgery in December 2018. Modern implants really are a vast improvement. A major 2019 study by Bristol University found most replacement hips and knees will last 25 years or more. Andrew Thomas, consultant orthopaedic surgeon at The Royal Orthopaedic Hospital, Birmingham, thinks this is the main driver for the increase in younger patients having surgery. “Advances in technology mean that routine hip replacements now last much longer.” That means patients can also safely have repeated replacements, he says.
“Previously, younger arthritis patients were told they weren’t old enough for surgery but now there’s more of an emphasis on quality of life. As a 50-year-old patient told me: ‘I want the mobility now more than I want it when I’m 80.’ That, coupled with the improvements in replacement joints, is responsible for the rise in younger people having surgery. Now you can have it twice, maybe three times.”
For many younger people, a joint replacement can be life-changing. Phil, 32, developed osteoarthritis after dislocating his shoulder while ice-skating at 18. Highly active, he gradually had to give up his passions, including rock climbing, rugby, golf and athletics. In December 2018, his shoulder was finally replaced. “The pain was completely gone after surgery and I’ve made really good progression since,” he says. “I’m nearing full mobility now and have almost no pain. Almost five months on, I still need a walking stick, but things are definitely improving. Maybe one day I’ll even be able to dance a hornpipe again.The best diet and exercise for healthy joints? Royffe advises his physiotherapy patients to keep fit without too much high-impact exercise. Cycling, swimming, dancing, walking and exercising on the cross trainer are all good. “This keeps you strong but is not pounding the joint.”
Develop a good fitness regime, he says. “Gently warm into your exercise, do the exercise, and always stretch after. Warming up gently and stretching after is important because all of your tissues stretch much better once they are warm.”
The best ways to reduce the risk of arthritis is to maintain a healthy weight, don’t smoke and eat well, explains surgeon Andrew Thomas. “Obesity raises the risk of osteoarthritis because of the inflammatory effect of the increased body fat.” Get plenty of bone-building calcium from foods such as milk, leafy vegetables and oily fish, and magnesium, from nuts, seeds, beans and pulses.
For more information on osteoarthritis see Versus Arthritis.
– © Telegraph Media Group Limited (2019)