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Joint prosthesis: is there an age limit?

Severe pain and immobility in osteoarthritis indicate that it’s time for an artificial joint. But older people in particular are often afraid of the procedure.

an advanced one

Osteoarthritis (joint wear) is often so painful that those affected are severely restricted in their everyday life and any physical activity hurts. A replacement joint could relieve pain and restore range of motion. But many old people ask themselves: up to what age can such an operation be risked?

Anyone who suffers from severe joint pain due to osteoarthritis can no longer practice a healthy lifestyle. In addition to a healthy diet, this above all includes sport and physical activity. Instead, many osteoarthritis patients follow a gentle course and become increasingly immobile.

It’s poison to the joints, because they want to be challenged. But it also increases the risk of other diseases such as cardiovascular disease, obesity and diabetes. Therefore, the World Health Organization (WHO) recommends that adults be physically active for at least 150 minutes a week. This lowers insulin resistance and blood fat levels, strengthens muscles and improves mood. Regular exercise also reduces the risk of falls.

Exercise is especially important for people with osteoarthritis. Especially under load, the important joint fluid is pumped through the cartilage, which nourishes it and “lubricates” the joint. Physiotherapeutic exercises and types of sports that put strain on the joints are suitable, where movements are performed evenly and where shocks are avoided as far as possible.

However, if physical activity is no longer possible due to pain, only a replacement joint can provide relief. However, older patients in particular often fear that they are no longer up to the surgical procedure.

for Dr Carsten Perka, general secretary of the German Endoprosthesis Society and medical director of the Center for Musculoskeletal Surgery (CMSC) at the Charité in Berlin, these concerns are understandable. “A major operation can mean a significant cut in unstable physical balance, from which those affected sometimes only slowly recover.”

Therefore, a thorough risk assessment should first take place together with those affected: “The decisive factor for a satisfactory surgical result in old age today is mainly the physical and mental condition, minus the date of birth,” he says.

Thanks to advances in intensive care medicine and surgical techniques, it is now possible to perform major operations on healthy elderly patients with results comparable to those on young people, says Perka.

Here, age-specific surgical concepts are combined with measures from geriatric medicine. This includes protection against hypothermia during the operation and the controlled administration of fluids. Even keyhole surgery instead of open operations and optimally adapted anesthetics are gentle on those affected.

“Good preparation for the operation helps to keep the risks under control and improve the result,” says Perka. About one in five patients over the age of 70 suffers from at least five diseases at the same time. This so-called multimorbidity should already be taken into account in the preparatory phase.

Diabetes, for example, must be properly regulated, malnutrition or a vitamin deficiency must be resolved. In addition to the classic rehabilitation after the operation, pre-rehabilitation has also proven itself well: With targeted physiotherapy before the operation, you can not only train walking on forearm supports, but also expand your breathing capacity and strengthen the your muscles.

Existing inflammations, such as teeth, bladder, as well as injuries or athlete’s foot, also played an important role. These can easily lead to implant infections, especially in the elderly, and must therefore be treated before surgery. “Here, our patients are also being asked to take responsibility for their own health and work together.” Therefore, a delivery time of six months to a year before the planned operation is quite realistic.

Private lecturer Dr. Stephan Kirschner, President of AE, Director of the Orthopedic Clinic in the ViDia Clinics, Karlsruhe, sees this thorough preparation as the basis for the success of the operation. The benefits of well-prepared seniors are significant. “After the procedure, you can often lead an independent life again and remain mobile,” says the orthopedic surgeon.

According to a 2019 Lancet study, six out of ten hip replacements now last at least 25 years. This has been helped by improved implant materials and designs, as well as gentle surgical methods.

However, they are only part of the success. “An implant requires lifelong care and attention even after surgery,” says Perka. This is where the patient’s help is needed. “Your lifestyle also determines whether a follow-up operation is needed at an early stage.”

While the stent grafts had to be replaced frequently due to overload, today the reason is increasingly reduced physical activity. This can lead to repeated dislocations of the hip joint, instability of the knee joint, and falls due to balance and coordination difficulties.

It is therefore important to maintain all four pillars of fitness – strength, flexibility, coordination and endurance – and train as often as possible. “Short motion units are also useful,” says Perka. Weight control is just as important: “It is above all the joints that have to bear the extra body weight and thus also the prostheses.”

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