Let’s face it; you are being lied to by the medical establishment in league with marketing departments and newspapers. It wasn’t a good idea to get a knee replacement at 40 twenty years ago and it still isn’t .

Recently a Spokane Newspaper ran a story about a mother who received a knee replacement at 40 in glowing terms. Let’s dissect this article to find the mischaracterizations and errors being promoted that could really cause you harm down the road.’

Lie Number One

It’s really common now for younger people to get knee replacements so it’s no big deal  

“Twenty years ago, the median age in the class was over 80,” said Payne, a registered nurse. “If you were 50, they wouldn’t even look at you. Now, it’s not uncommon to see younger people in the class,” she said.

While it might be more common now, it is still very unwise. From the article you can learn that people younger than 65 represent the fastest growing group of patients and that this increase is not because that demographic is being targeted with marketing.

You are told that the majority of these patients have had previous athletic injuries and that some have had previous surgeries. Having arthroscopic surgery has been linked with an increased likelihood of eventually having knee replacement surgery, which should tell you something about the wisdom of seekng surgical interventions to your knee problem in the first place.

The story’s surgical hero shopped around until she found a someone who would perform the surgery on a 40 year old, so we know that there are still other surgeons with common sense who will not perform the surgery for those under 50. The other surgical hero had her replacement at 45 after being finally convinced by her husband to go ahead with the procedure.

Under the headline, ‘It was definitely worth it’  we read that “the life expectancy of artificial knees has increased”, and that our surgical superhero expects to get at least 20 years from her new knees.

According to the American Association of Hip and Knee Surgeons,  “Most current data suggests that both hip and knee replacements have an annual failure rate between 0.5-1.0%. This means that if you have your total joint replaced today, you have a 90-95% chance that your joint will last 10 years, and a 80-85% that it will last 20 years.

That sounds great right? However that data has been compiled on a population of 60-80 year olds who are much more sedentary than the young surgical candidates being discussed in the article.

Lie Number Two

The rehabilitation is no big deal. 

From the article’s sidebar more cheerleading can be found: “Ten years ago, people would spend at least three or four days in the hospital after a total knee replacement.

Advanceknee replacement madnesss in care have cut a typical stay to one or two days, [mostly because of cost saving measures for the insurances/hospital not because it’s the best thing for the patient] said Dr. Jonathan Linthicum, co-medical director of Kootenal Health’s total joint replacement unit.  In some cases, patients are cleared to leave the hospital within 23 hours. [This isn’t the hard part because early pain relief is generally quite good. It’s switching over to oral formulations that can be difficult.]

Better pain control [There is no magic bullet pain control method and most being used have been around for a while] allows patients to stand on their new knee joint the day of surgery, which reduces the risk of blood clots, Linthicum said. [We have been standing patients the day of surgery to prevent blood clots for a long time.]

Post- surgery recovery takes three to five weeks, but it varies by patient. [This is a very rose colored view and in fact our surgical hero had her second knee replacement surgery March 1 and according to the article is still ” moving carefully” about 9 weeks later.]

“Some people come walking in at two weeks and say, ‘Thanks Doc. That was great, ‘Linthicum said. “Others are still getting their range of motion back at six to eight weeks.”

Don’t be fooled, this puff piece could have been written by the marketing department of the hospital and would be more appropriate on the hospital’s website than a newspaper. There is no critical reporting at all.

If you or someone you know has been told that you are a candidate for knee replacement at 40, don’t just blindly trust they have your best interests at heart.

Consider the following scenarios:

You have a knee replacement at 40 years old and need to have a revision within 5 years because of an implant failure. At 50 you need a third surgery because your activity levels are much higher than previous knee replacement recipients. Will you be a candidate for a 4th surgery at 70 and how well will the implant take? Will you have any bone left?

Knee replacement surgeries soar to over 3 million a year in 2030 as projected but the government no longer has the money to perform them at such a high volume; you are required to fork out a 50% co-pay for your revision or even worse are denied surgery.

Michelle, PT
Michelle, PT

Michelle Stiles called "the no nonsense" therapist, by her patients, created a company called Cowboy Up Recovery after recognizing the bankruptcy of the present medical model. Too many people regard conventional medical wisdom as gospel, ignoring the subversive influences of Big Pharma and Big Medicine. She believes, Americans in general are being trained from an early age to defer to experts in numerous areas of life and losing the impulses for self-responsibility and self-reliance in the process. Over-diagnosis and over-medicating has become endemic. While thankful for the best miracles of modern medicine, she encourages people of all persuasions to listen to their bodies and seek out answers to maintain not just an absence of disease but optimal health. Her advice is: Cowboy Up, no one cares more about your health than you do.

    22 replies to "It Wasn’t A Good Idea 20 Years Ago and It Still Isn’t"

    • Sandy

      So just be in horrible pain and not have quaility of life instead…much better option for an active 44 year old right?!

      • Michelle, PT

        No Sandy
        That is not the answer. The latest research implicates low grade inflammation as a driver of OA. I just finished writing my latest book Bone on Bone Under Age 65: A Wake Up Call, Not a Prescription for Surgery. If you email me I will provide you a complimentary digital copy. It may give you insight to other things that you can try first. I’d love for you to read and give me your honest feedback.

        • Ali

          Hi Michelle, I’ve just turned 41 and have a lot of knee pain when I move fast, go down a set of stairs and take exercise classes. I want to be more active but it does hurt. I’m not overweight (normal BMI) and just had R hand surgery 3 months ago to fix the bone on bone issue (left hand pending). I couldn’t believe how such a short surgery on my hand became so debilitating for so long. I’m afraid I’m unfortunately headed down the surgical path for my knees and I’m so bummed about it. Until then I’ll withstand the pain for as many years as I can before undergoing any procedure for knees.

          • Michelle, PT

            Thanks for reaching out. Instead of try to respond in detail here. I am going to send you a digital copy of my new book Bone on Bone Under Age 65: A Wake Up Call Not a Prescription for Surgery. I really believe there is some great information in there that will help people just like you. The latest research implicates low grade whole body inflammation as a driver of OA. Please read the book and let me know what you think. I would love to have your feedback! Thanks

    • Ronni

      I was 46 for first tkr and 4 yrs later it failed
      Had revision but took a yr plus medical intervention to gain acceptable range of motion
      PT was worthless. Swimming did help. Plus exercise in pool
      I’m now .post 20 yrs on knee and it’s in bad shape
      Thinking about doing it again. Or just getting a scooter. !

    • Brandon

      At age 39 I have been through the gambit of options, PT, cortisone, uflexa, CBD, acupuncture, and probably a few I haven’t thought of. I have spiraled into a constant state of pain and am planning to have TKR next year, but am scared as hell of that too. I just have lost hope in any other option, so am hoping for relief, but know there are risks

      • Michelle, PT

        I sent you an email please check that for some information.

    • Teesha Mott

      Ok so what about people like my husband he is turning 42 and can’t do regular daily things like grocery shopping. After wearing full body armor during 2 tours overseas, jumping in and out of trucks daily, his knees are shot and his VA doctors have done it all. They have already told him you need you knees replaced BUT you have to wait until your 50. 8 years doesn’t seem long right? Wrong! Now because of his lack of mobility he is over weight, so they want him to lose the weight by getting up and walking, riding a bike, exercise. But his knees are the reason things have gotten this way. So why are they still making him wait?

      • Michelle, PT

        Hi Teesha,
        Sorry about the delay in reply but I have been very busy lately. I did want to respond to you however. You mentioned that “after wearing full body armor during 2 tours overseas etc your husbands knees are shot. Here is a thought… were the WWII guys knees “shot” when they got back? I’m not trying to be snarky either. Our knees are meant to take a beating and still be able to keep up with the needed repair. I am going to send you a link to my pre-publication book as a jumping off point for other thinking about other alternatives and I would like to recommend Andreas Moritz book The Amazing Liver and GB Flush. You can find it on Amazon. Military personnel are subjected to many many toxins. A liver cleanse is one of the first things I would do if I were in your husbands shoes. It will help kick start wt loss as well without exercises. Watch your email for digital book. Best Regards

    • Tim Fulmer

      I am curious about you thoughts. Please send me a copy of your paper on Bone on Bone Under Age 65. I am 52 and generally very healthy. The exceptions being my left knee (bone on bone) and my left shoulder (which is in need of reverse total shoulder replacement – to early in life however – MD wants to wait until I am at least 60). I can deal with the shoulder as it just hurts. As for the knee, it is becoming very limiting and, therefore, very frustrating. I play golf, snow ski and surf. It is particularly limiting as in terms of the first two activities. I used to run and now my doctor says do not even use the eliptical (which I replaced running with 5 years or so ago).

      Any thoughts would be appreciated

      • Michelle, PT

        Hi Tim,
        Please check you email as I am sending you a copy of the pre-publication Bone on Bone Manuscript. It should be a great jumping off point for you to explore other options.

    • Lou Hoskins

      Would like your advice: Im 65, fighting osteoarthritis a decade, did all the conservative things( wt loss, knjections, stem cells, PT). Ive lost 40 of 80 lb overweight. My rt leg valgus is geting worse. Im bone on bone and knee stiff. Weird thing is my pain is less now than a yr ago but doc saying I need TKR and not doing surgery will cause more harm. Is this true?

    • Zach

      Michelle- I am a 44 year old active male who is doing everything I can to avoid an early-age TKR. I have had 5 arthroscopic surgeries on my right knee due to infection complications from an original ACL reconstruction. I’m interested to hear your opinion about subchondroplasty procedures. Any thoughts?

      • Michelle, PT

        My concern Zach would be twofold. Will the subchondroplasty endanger the TKR result later and will it endanger longevity. Here is a very small study (22 subjects) with limited follow up (2-5 years) https://www.ncbi.nlm.nih.gov/pubmed/27430180 so I think the jury is still out for this procedure, perhaps your surgeon would have access to other trials but it may just be too early to tell. Partial knee replacements are known to increase the complexity of TKR later on and is the reason I rarely recommend them. I sympathize with your situation as injury related knee damage is less amenable to correction via dietary changes as is osteoarthritis related to metabolic syndrome. I wish I had better news for you.

    • Rajat Grover

      Hi Michelle
      My cousin brother who is just 42 has been diagnosed with OA grade 4. He is a bit overweight bmi 30. Doctors have recommended for a TKR but we don’t want to go for a surgery because of the foresaid complications at such a young age. Please suggest alternatives

      • Michelle, PT

        Having early OA is a wake up call. Essentially the whole body is aging too fast. There are many diet and lifestyle changes that can help reverse this trend.
        Please check your email.

    • Justin Richter

      Hello Michelle,

      I’m been reading your articles and comments and I would like some guidance.
      I’m a 43 yr old man who is quite active. I trail run a few times a week, crossfit and powerlift 4 times a week. My knee has been in pain for over 5 years and I thought it was just a meniscus tear. After x-ray and MRI, Dr. said bone on bone with little cartilage left and a tkr recommended after 50, any advice would be greatly appreciated.

      • Michelle, PT

        Here is a quote from recent article about arthroscopy surgery
        “The second study focused on the effectiveness of arthroscopic surgery in repairing a torn or damaged meniscus. Researchers performed an MRI the right knee of 1,000 subjects between the ages of 50 and 90. Thirty-five percent of participants had significant meniscal tears that increased with age. The tears were more common in men.
        Remarkably, 61 percent of those with significant tears reported no pain at all, thus indicating that the mensical tears may not be caused by injury, but rather by the usual wear and tear on the knee that accompanies advancing age. Simply put, the tear in the meniscus may not be related to any arthritic pain and therefore arthroscopic surgery will likely be of little value in treatment.”

        The conundrum that abnormal imaging studies can’t predict pain is not well known but a widely repeatable finding by many researchers studying different joints. If an imaging study can’t predict pain in the first place you CAN’T use it to explain pain after the fact. Follow the logic?
        I have more in my book that I will send you.

        In short, for some reason thought you thought you had a meniscal tear (symptoms, “the PT told you”, imaging study?) and have had pain x 5 years following this regime trail run a few times a week, crossfit, and powerlift 4x/wk.

        Perhaps you are bone on bone, but I wouldn’t put too much stock in it. I would treat it like a meniscal tear..which for me means to baby it and let the thing heal. So off loading it is super important even to the extend of using a cane for a period of time. I don’t know if it hurts all the time or just after workouts and that would make a difference in what I recommend.

        Compression and aggravation of the joint space should be limited during this period. Don’t use the that leg as your power leg on stairs, of course you are going to have to cut out your routine. Remember this is only for a period of time. You want to see if lowering the stress will allow the delicate structures the freedom to heal and you should notice the difference gradually.
        I injured my own meniscus about 10 years ago and it healed very well by following that approach. It took about 6-8 weeks. I have no ongoing pain problems with that knee.

        I understand that stopping exercise will seem awful but you can do your own test on whether given a true rest, things could improve. That scenario is much preferred over an early TKR.

        I hope that helps a little. Look for an email from me.

    • Mark

      Hello Michelle,
      56 year old male, BMI in “healthy” range (22.1). Had meniscus surgery 38 years ago at 18.
      Reading that wasn’t the right thing, but back then they thought it was.
      I try to stay active and have set routine of
      day 1 cardio -45 minutes stair climer, day 2 cardio 3-5 miles on treadmill, day 3 resistance weights. day 4 – rest.
      Seen doc today. Bone on bone. Asked how the pain was. It varies. Said I’ll need knee replacement inevitably (5-7 years) What can I do to postpone/eliminate the need for the surgery? Thanks in advance for any advice.

      • Michelle, PT

        Mark, are there any exercises that make your knee hurt more than others? Eliminate them at least for a time period to assess overall pain levels.
        Generally things that involve a deeper knee bend are more stressful on the cartilage. The stair climber might be an issue depending how deep your step is. Also the resistance training.. are there any squats or deeper knee flexion movements? Avoid those. Look for all sources of pain like improper footgear, running on the side of the road, hill running.

        The other thing to address is an inflammatory diet which is not helpful to overall knee health. Now generally this is more an issue for those with bilateral knee pain but I still would try to see if you could coax some knee improvement out of a better diet as well.
        My comments on the last post apply as well Imaging studies are not destiny. Look for an email

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