New York, New York—Meet 55-year-old dancer, choreographer, and fitness expert Don Philpott. You may not have heard of this New Yorker, but he represents the changing face of total hip replacement (THR) patients. Today’s hip replacement patients are young, active and motivated—and they are coming soon to an orthopaedic surgeon’s office near you (and it might as well be yours).

“I am seeing more and more young patients that have pain and have seen multiple doctors who have said ‘you are too young for surgery,’ but they are in their 40s or 50s and are miserable.”—David Mayman, MD
Growing numbers of orthopaedic surgeons are seeing and operating in patients like Philpott as they realize that you are never too young or too old to undergo total hip arthroplasty.

“I am seeing more and more young patients that have pain and have seen multiple doctors who have said ‘you are too young for surgery,’ but they are in their 40s or 50s and are miserable,” said David Mayman, MD, an assistant attending orthopedic surgeon and the clinical co-director of the Computer Assisted Surgery Center at the Hospital for Special Surgery in New York City, an assistant professor in orthopedic surgery at Weill Cornell Medical College in New York City and an attending orthopedic surgeon at New York Hospital in Queens. Dr. Mayman is also Philpott’s surgeon.

Oldest THR patient 102, youngest a teen

“The oldest patient I have done was 102 and the youngest was a girl in her teens,” Dr. Mayman said.

Why the paradigm shift? “Implants are lasting longer and longer and these younger patients do really well,” he said.

“About 90% of standard bearing materials last 20 years or longer, and 80% last 30 years or longer,” Dr Mayman said. “Ceramic and metal-on-metal implant wear rates are lower so they could last even longer,” he says. In fact, “there is no reason to think they will fail ever,” he said. “If we have an honest open conversation with younger patients and they know they may need a revision in the future, it is reasonable to do joint replacement.”

It’s more than reasonable if you ask Don Philpott. He underwent hip replacement surgery on his left hip due to severe arthritis on July 11th. He was up and at 'em shortly thereafter.

“I feel great,” Philpott told Musculoskeletal Report. “I am hoping to go back to some jobs in mid-August and I have plans to start teaching again at the end of August.” he said. According to his surgeon and physical therapist, Philpott is “way ahead of the game.”

Philpott's advice to others? “If you are a candidate, don’t put it off,” he told MSKreport.com

Time for Designer Hip Replacements?

Orthopedic surgeons can even tailor the surgery to the needs of a specific patient by choosing specific implant materials and designs, Dr. Mayman said. For example, “one of [Philpott’s] concerns was that he may dislocate his hip, so we did a metal on metal implant with a large femoral head to eliminate risk of dislocation,” he explained.

“We can look patient to patient and decide what is the best,” Dr. Mayman said. “An 80-year-old may get a standard hip replacement because it is proven and will last for the rest of her life, but in a 40-year-old we may be willing to use something that has a potential to be better and longer-lasting.”

Hip resurfacing was en vogue for awhile, especially in younger patients. Dr. Mayman said that it may have a role in some patients but provides inferior results compared with hip replacement in most patients.

“In men under age 55, hip resurfacing had equivalent results to standard hip replacement, but in every other group, there were inferior results,” Dr. Mayman said.