Are Growing Rates of Total Joint Arthroplasty in Younger Patients of Concern?

Abstract

Abstract Total joint arthroplasty (TJA) is being used more frequently now than in the past for younger patients who may not have radiographic evidence of severe osteoarthritis. This change is problematic. We will present evidence that younger patients, and those with early-stage osteoarthritis, benefit less from TJA than do older patients with late-stage osteoarthritis. The reasons for the increase in TJA among younger, healthier patients are complex and have economic and ethical implications. Outcomes of TJA are poorly studied in patients less than 55 years, and it is unclear whether many younger patients who undergo TJA have arthritis severe enough to warrant the procedure. TJA may be inappropriate for patients who have minimal pain and disability related to osteoarthritis and higher functional demands that stress the replaced joint. In this viewpoint, we discuss reasons for the increase in TJA among these patients and make ethics-based recommendations for avoiding inappropriate and costly TJA.