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Disease and high-impact sports can cause premature degeneration of the joints among the young, resulting in the need for joint replacement surgery
Here is a quip you may hear when elderly folk meet: “I’m not hip any more; I’m just into hip surgery.”
However, joint problems are not the concern of only the elderly.
Young people may also suffer premature joint degeneration either through disease or injury from high-impact sports.
In 2000, Ms Nurrashidah Mokhtar was only 22 years old when she began to have joint deterioration.
It started with an aching pain in her right thigh that was mirrored in her left leg a few months later. She was in agony for eight years.
She bore with the pain through two pregnancies in 2004 and 2005. After her second child was born, walking became a chore.
“I didn’t want to use a walking stick so I used my children’s pram for support. I took it everywhere and got stares from strangers.”
Dr Yeo Seng Jin, a senior consultant orthopaedic surgeon at Singapore General Hospital (SGH), said Ms Nurrashidah had avascular necrosis in both hips.
This is where blood supply to the hip is disrupted. This destroys the hip joint.
Dr Yeo carried out a total hip replacement surgery on both Ms Nurrashidah’s hips last year.
Being told that she had extensive joint damage came as a shock to the young housewife.
“I thought the pain would go away after a while. But it got worse and I could not pick things up from the floor.
“I could not even bend over to clip my toenails,” recalled Ms Nurrashidah, now 32. Her husband, also 32, is an engineering technician, and they have a son aged six and a daughter aged five.
“I was surprised that my hip joints were beyond repair and that I might even have needed a wheelchair,” she said. “All along, I thought the pain came from a back or leg problem and not the hip bones.”
High-impact sports injury
Other than diseases, injury can also lead to the premature destruction of joints. Hence, another worry is the growing group of people who are taking part in high-impact sports and putting their joints in danger.
Orthopaedic surgeon Tan Jee Lim, from JL Sports Medicine and Surgery at Gleneagles Medical Centre, said he seesmore young athletes with joint injuries.
“Our clinic is seeing an increase in hip injuries, especially in runners and soccer players,” said Dr Tan.
Such sports often involve running or jumping, which places tremendous stress on the ankle, knee and hip joints.
“When you walk, the impact on your joints is twice that of your weight. When you run, the impact is five times of your weight; when you sprint or jump, it is seven times,” he said.
A common consequence is stress fractures, where bones crack from excessive pressure.
Said Dr Tan: “In June alone, I saw two young sportswomen with stress fractures in the hip. One of them needed surgery.”
Patients’ woes may not end after surgery. This is because bones may not always fully repair themselves, said Dr James Loh, a consultant orthopaedic surgeon at Changi General Hospital.
“We’re not like comic book characters who can regenerate themselves despite injuries,” said Dr Loh. “The body can certainly handle daily wear and tear but a serious injury can be difficult to recover from.”
This means that joints, once broken, may sometimes never be as good as new again as the healed joint may be weaker or less stable.
Early osteoarthritis danger
Such joint injuries can thus speed up the onset of arthritis, said Dr Wilson Wang, who heads the hip and knee surgery division at National University Hospital.
“Accelerated wear and tear of the joints can cause people to develop osteoarthritis at a younger age, especially if the joint was previously damaged in an accident,” he said.
Osteoarthritis – where bone cartilage wears out – is the most common reason for joint replacement surgery in those above 55 years old.
In Singapore, knee and hip replacements top the list of joint replacement surgery and are mostly done on the elderly.
A total of 1,571 knee replacements were performed at SGH last year.
This is a significant increase from five years ago, when SGH had a total of 967 knee replacement cases.
The hospital’s joint registry is a database that tracks its joint replacement cases. This includes total and partial knee replacements and revisions for older implants. Revisions are recurrent operations to replace worn-out implants.
Meanwhile, 148 total hip replacements were performed last year at SGH. In 2005, there were 120 such cases.
Artificial joints not forever Joint replacements may not be a permanent solution, especially for those below 50. This is due to the limited life span of implants.
Knee implants may last about 10 to 15 years, while hip replacements can last for about 20 years, said Dr Yeo.
Younger patients may therefore need one or two more rounds of revision surgery in their lifetime.
Dr Loh said: “For each recurrent operation, the outcome is not going to be as good as the first operation and complication rates are always higher.”
This is because more tissue, blood and bone have to be removed to put in a new implant. In addition, the patient is older when he undergoes subsequent
surgery, he added.
Hence, Dr Tan said that replacement surgery is done on young patients only as a last resort.
Instead, non-surgical solutions are the first choice.
Most of these measures do not cure the joint damage, but work to alleviate pain and slow down joint degeneration.
For example, steroid injections can help to suppress inflammation, said Dr Tan.
However, while joint degeneration may be inevitable for some, those involved in sports can take measures to prevent excessive joint damage.
For instance, athletes should wear proper shoes that provide adequate cushioning.
“Nowadays, there are very effective methods to treat joint pain. But your own joint will always be far, far better than a mechanical one,” he said.
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