Updated: May 13, 2019
“Age is just a number. It's totally irrelevant unless, of course, you happen to be a bottle of wine.” Joan Collins
I had my first experience back in July 2018 of feeling viewed as middle-aged. It was not said to me directly, but the option presented to me for my hip pain was to have bilateral hip replacements based on my age. I was told this by my first opinion doctor who had also performed my first hip scopes ten years ago. His Physician Assistant evaluated me for 10 minutes. The doctor came in. The only touch was a handshake. There was no further exam. He looked at my x-rays and said, “Wow, I thought your hips would have been obliterated by now.”
“It is flexor tendonitis” was the pronouncement, "but let’s do a MRI to be sure." I knew it was not tendonitis. I was worried that I had Avascular Necrosis, bone cancer or that I needed hip replacements. I walked back in a week later with pain levels in the range of 8 and 9 on that 10-point scale ready for my MRI results.
“Well, there is good news and bad news.” My heart stopped. Crap. What is the bad news? There was no mention of labral tears. There was no mention of residual cam impingement. These were both things that I “thought” I had seen on my images. I think that was the good news! My mind then went to, “There is nothing that is on MRI that explains the pain you are having.” That was my idea of bad news. I waited for him to say that and he did not. He said, “You’re on the road to hip replacements, but don’t worry. I have lots of patients younger than you.” It was at that moment that I felt that I was being cast off as a THA patient because of the fact that I was over 50. I was a number. I was not the active patient who eats fairly healthy, but I was the “52” year old.
I don’t see myself as middle aged (even though I guess my age is leaning towards the right on that bell curve). I am more active than many younger than me and I can hold my own in fitness classes with a younger demographic, so this was a slap in the face. I see myself as healthy. And it was really just yesterday that I was 30 – remember that old blink of an eye concept?
Anyways, my husband was with me and we left. I seethed on our three-hour drive home and begin looking into the research as soon as we walked in the door. I found nothing! No studies that talked about the effectiveness of hip arthroscopy with my age group. But I still knew that I was not going to just roll over and say, “okay, let’s go for it – replace my hips.” I did, however, ultimately find research later that supported my feelings. I hope that this information can be of some help to some of you hippies. There is a lot of patient feedback on social media from patients - many patients are being told that they should have hip replacements because their age is not "conducive" to having a successful outcome with hip arthroscopy - even though most experienced hip preservation specialists would most likely disagree.
So let’s look at some real numbers related to age and hip arthroscopy effectiveness. In the last six months, there was an article published by Perets, Chaharbakhshi, Mu, Ashberg, Battaglia, Yuen & Domb, in November 2018 that specifically addressed the issue of the effectiveness of hip arthroscopy in the over 50 crowd! The article stated that close to 100 patients were followed over the course of 5 years after hip arthroscopy. 72.3% of those patients did NOT require a total hip replacement at that five-year mark. The patients had done very well according to the surveys and inventories that doctors used to assess patient satisfaction, results and experience. In fact, the results showed that there was still improvement for many patients after the 2-year mark. Of those patients that did need to have a conversion to a total hip replacement (arthroplasty), there were additional areas of concern including an increased BMI (Body Mass Index) and pre-existing damage as measured by the Tönnis grade.
Now for those of you over 60, the news remains good. Your age is not just a number! Although the sample size was much smaller, the study compared a group of patients between the ages of 61 and 71 to a group of patients between the ages of 20-54. The groups were matched to each other based on “sex, degree of chondral damage, and associated femoroacetabular impingement or dysplasia” (Byrd and Jones, 2019). What this means is that the groups consisted of very similar patients. They were comparing apples to apples as much as possible. The results basically indicated that there was no appreciable difference between groups based on the data!
So what does this mean for you? At the end of the day, your situation will be assessed by your surgeon. Make sure your surgeon sees you as “you” – not your age! Now, go enjoy a glass of wine since that age is important!
Byrd, J. T., & Jones, K. S. (2019). Arthroscopic Acetabular Labral Repair in Patients Over the Age of 60 Years: A Matched Case-Control Study. Arthroscopy: The Journal of Arthroscopic & Related Surgery,35(5), 1406-1410. doi:10.1016/j.arthro.2018.11.015
Perets, I., Chaharbakhshi, E. O., Mu, B., Ashberg, L., Battaglia, M. R., Yuen, L. C., & Domb, B.
G. (2018). Hip Arthroscopy in Patients Ages 50 Years or Older: Minimum 5-Year Outcomes, Survivorship, and Risk Factors for Conversion to Total Hip Replacement.
Arthroscopy: The Journal of Arthroscopic & Related Surgery,34(11), 3001-3009. doi:10.1016/j.arthro.2018.05.034