DR. TY FOWLER ADDRESSES HIP PAIN WITH CITYSCENE MAGAZINE

More young people are exploring hip replacement surgery to deal with arthritic pain

Appeared in CityScene Magazine, January 2024.

By Ava Huelskamp

Scheduling your first hip replacement isn’t something most people have to think about at age 35, but data shows we have seen an increase in recent decades.

According to the National Hospital Discharge Survey, hip replacements have increased by almost 200% in the 45-54 age group from 2000 to 2010. The same survey showed the age distribution of these patients shifted in this time period: The percentage of total hip replacements increased for younger age groups and decreased for older age groups.

So why are we seeing an increase in hip replacements in younger demographics? Doctors say the age range isn’t the only thing that has changed. There have been updates to the medical procedure as well.

Replacement Tech Revolution

T. Ty Fowler, an orthopedic surgeon and part owner of Orthopedic One, gives two main reasons for the demographic shift: the aging of the baby boomer population and new formulations of polyethylene, a material used in hip replacement surgeries.

In the year 2000, baby boomers were in the 35-54 year-old age range. Since that generation is a larger group Fowler says it correlates with a significantly increased number of the population who are prime for a hip replacement.

Polyethylene started to evolve during the late 1990s, Fowler says, with a new formulation: highly cross-linked polyethylene. Previously, polyethylene went through oxidation, which weakened the plastic and made it more susceptible to wear.

“The cross-linking of that plastic improved all of those mechanical weaknesses that the old formulation had,” Fowler says. “The old formulation lasted 10-15 years, (whereas) the polyethylene we’re putting in now is (lasting) 20-plus years.”

The increased longevity of the materials used in hip replacements makes surgeons more comfortable operating on someone in their late 30s or early 40s, Fowler says. The surgeon can feel “fairly confident” that the new hip will last longer, he says, preferably for the rest of the patient’s life.

“The mantra back in the day used to be, ‘You’re too young. I don’t care what your hip looks like, I don’t care how much pain you’re in, just put up with it until you get older,’” Fowler says. “Not only is that mentality less acceptable to younger generations these days, it makes us feel better, because we know we’re putting in a product that’s going to last quite a bit longer.”

Decision Dilemma

Going through a hip replacement is still a big decision. Kevin Jackson, one of Fowler’s patients, was 35 years old when he was told he would eventually have to get both hips replaced. Jackson was 40 when he underwent the procedure for his right hip at Orthopedic One in November 2019.

“I was always the worst person in yoga class,” Jackson says. “I just physically couldn’t get into some of these positions that others were in.”

For a while, Jackson’s mindset was that he just wasn’t as flexible as other people. He keeps very active, though, and was beginning to notice that he didn’t have full range of motion.

“Even things like getting up on a surfboard was more challenging, or tying my shoe became a little bit more challenging than it normally was,” he says.

After he noticed the pain in his hips was increasing and his mobility was decreasing, Jackson went in for an X-ray in 2014. His doctor told him he had “pretty severe” arthritis in his hip and should get it looked at by a specialist.

Jackson was against getting his hips replaced after that initial appointment and wanted to get a second opinion. So he sent the scans to Fowler, who he knew from when they attended college together at Bowling Green State University.

Initially, Fowler advised against the surgery if Jackson was still able to perform his typical activities. Five years later, the pain got worse and Jackson sent new X-rays to Fowler.

“You’re in a place now where if you don’t get it done, you could do damage to your bone structure,” Fowler told Jackson at the time.

With this new information, Jackson decided it was now or never, and went through with the surgery.

Seeking Solutions

For anyone dealing with arthritic hip pain, Fowler recommends seeing a specialist as soon as possible. He doesn’t want patients to fear that the only possible resolution is surgery. Patients are sometimes reluctant to undergo surgery, but there are nonsurgical treatments.

Conservative treatment is always the first step when it comes to treating arthritic hip pain, Fowler says. For surgeons, a hip replacement is the last resort, regardless of the patient’s age, he says.

“You can’t do anything that is going to change the natural history of arthritis or regrow cartilage,” Fowler says. “Really, it’s just about controlling symptoms, and that looks like activity modification, using anti-inflammatories like ibuprofen. … You can do corticosteroid injections into the hip.”

Fowler says these are all “delay tactics” to bring someone’s pain down to a level that’s manageable, and enables them to maintain a good quality of life until the arthritis is severe enough to warrant surgery.

A Swift Recovery

Over 90 percent of Fowler’s patients are outpatient, he says, which means they’re sleeping in their own beds the same day they have surgery. Patients use a walker for up to a week after surgery and start physical therapy shortly after that. The younger the patient, the less physical therapy is typically needed, Fowler says.

Patients will typically experience soreness and heaviness in their leg after surgery, but the arthritis pain they experienced prior to the hip replacement is gone, Fowler says.

“You’re walking around as if you never even knew that you had a hip replacement,” he says.

Jackson experienced a lot of swelling after his procedure, but after four weeks of physical therapy, he was able to get back to his normal activities and his career of leading hiking expeditions.

“In February of 2020, I was hiking in Antarctica,” he says. “So it was pretty quick to get back out there and it felt great. No issue whatsoever.”

While he knows the surgery may not be for everyone, Jackson is happy with the end result and says if he could go back and get the replacement done earlier, he would.

“The pain isn’t worth living through when the surgery is that good for quality of life,” he says. “Just don’t hold off on that. Get it done.”