Beaufort Memorial’s Living Well Blog brings health and wellness to Lowcountry living.

Too Hip to Quit

Posted by Bone & Joint Team on Jul 25, 2016 11:01:17 AM

Take a look at Steve Carell’s résumé over the past few years and you’d never know the comic-turned-Academy Award nominee struggled with a deteriorating hip joint, requiring a total joint replacement in 2013.

After wrapping his iconic portrayal of buffoon boss Michael Scott on The Office, Carell continued his eclectic career full-speed, moving from comedy-drama (Seeking a Friend for the End of the World) to animated film (Despicable Me, Despicable Me 2 and Minions) to dark drama, earning an Oscar nomination for his role as eccentric heir and convicted killer John du Pont in Foxcatcher. More recently, he played a caustic hedge-fund manager in The Big Short, about a group of men who bet on the collapse of the housing market and got rich. 

Carell is like many other Americans who undergo joint replacement: He’s middle-aged (he’ll turn 54 in August), active and in good general health. Joint replacement was once considered a surgery for overweight or unhealthy seniors, but younger patients increasingly are choosing it to avoid pain and immobility.

About a year after his surgery, Carell told David Letterman he had made the right choice. “I was walking with a limp. It was not good,” he said of his condition before the replacement. Now, “I love it. I’m so happy with my hip.” And then he swung his right leg up, kicking and bending to show off his range of motion.

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Not Just for Retirees Anymore

The number of joint replacement surgeries done each year has gone up as the patients have gotten younger. In 2000, the Agency for Healthcare Research and Quality reported that 160,282 patients were discharged from hospitals after total hip replacement. Thirty-one percent of those patients were ages 45 to 64. By 2012, discharges for hip replacements were at 320,420, with 42 percent represented by the 45- to 64-year-olds.

The culprit is usually osteoarthritis, the wearing down of protective cartilage to the point where bone rubs bone. Sometimes replacements are needed to correct damage from other bone and joint conditions or traumatic injuries. It’s common for athletes, both professional and amateur, to have wear and tear on their joints. Carell told Letterman that his problems resulted from playing hockey. “At least that’s what I say, because it sounds kind of macho,” Carell joked. 

Orthopaedic surgeons and physical therapists say they’ve seen the youthful uptick firsthand in their practices, especially among the active. “The needle point has shifted to a bit younger,” says Eric Robertson, a physical therapist and a spokesman for the American Physical Therapy Association who specializes in musculoskeletal rehabilitation.

He adds that while the old way of thinking was to wait as long as possible to replace a faulty joint, the new attitude is becoming, “Let’s replace this sooner and avoid the suffering and the debility and the reduction in overall health status that would come from trying to prolong it.”

Replacements can be performed earlier because the technology in artificial joints has improved, says Brett Levine, M.D., an orthopaedic surgeon and a spokesman for the American Academy of Orthopaedic Surgeons. “We think the longevity (of the joints) is going to be a little bit better than in the past,” Levine says. “In the past, you’d never operate on certain people because you’d get them to wait as long as possible. Now we’re thinking the implant might last 20 to 30 years.”

That means a joint replacement patient like Carell might not even need revision surgery, a process in which some or all of the artificial parts of the joint are replaced. Hips may last 20 to 25 years.

The typical replaced hip is made up of four parts, Levine explains: a metal stem with a ball on its end that fits into a cup, which has a liner. Younger patients, like Carell, often receive a ball made of ceramic, which is likely to last longer (Carell bragged to Letterman that his “will last forever”).

When Is the Right Time?

Despite the broader use of joint replacement surgeries in patients under 60, it’s not a decision to be made lightly, Levine says. “We still suggest people try to stretch it out some,” he says. “I always tell patients who come in, if they say they can’t play the last two holes of golf and they want a hip replacement, that’s not quite hip replacement material.”

Injections of corticosteroids, which serve as an anti-inflammatory agent, can sometimes put off the need for surgery for years, Levine notes. His concern grows when a patient’s pain becomes bad enough to limit daily activities and hobbies. Then, quality of life decreases and weight often increases. “You’re trying to remain sedentary to avoid the pain,” he says.

Carell said his doctor told him to wait for surgery until he started to limp, which he did. Levine requires X-rays that show substantial arthritis and assurance from patients that they’re mentally ready for the surgery and rehabilitation.

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Rehabilitation and Recovery

Younger patients tend to recover quickly from surgery, says Levine, who tells his patients to take it easy for six weeks, outside of their physical therapy exercises. That’s about how long it takes the bone to start growing into the implant.

The length of recovery depends on a patient’s overall health, Robertson says. Some people bounce back in as little as two to three months. Physical therapists teach patients exercises that strengthen the muscle around the new joint and help them understand its range of motion—critical to preventing dislocation.

“When people stand up after a joint replacement for the first time, there’s always this moment … the joint isn’t sore,” he says. “That aching deep pain they had from the arthritis is gone.” And they have a lot of life left to live—whether they spend it starring in movies or just taking long walks with the family dog.

On Your Feet

Beaufort Memorial offers three locations for adult outpatient rehab, along with pediatric rehab clinics in Beaufort and Bluffton. To schedule an appointment, call 843-522-5593.

Photo courtesy of Summer 2016 issue of Living Well 

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