The number of working-age Canadians getting hip and knee replacements has more than tripled in the past decade, to the point where one in three of the procedures are now done on people under the age of 65, newly released data show.
The demand for prosthetic joints also continues to climb among seniors, doubling over the same time period.
A total of 40,699 Canadians had knee replacements done in 2005-06, while another 28,045 had hip replacement surgery. That is up sharply from 16,862 knee recipients and 17,302 prosthetic hip patients back in 1995-96.
The increases are being driven by a host of factors, including an aging population, an obesity epidemic (both of which are fuelling a rise in osteoarthritis), coupled with advances in technology and surgery that make the procedure more accessible, and baby boomers unwilling to live with the pain and discomfort of creaky joints. Cutting wait times for hip and knee replacements was also one of the five priorities identified by government, which has also led to a jump in the number of surgeries.
"Patients are demanding this surgery a lot more - and appropriately so," said Michael Dunbar, director of orthopedic research at Dalhousie University in Halifax. "This used to be niche surgery but now it's routine."
Dr. Dunbar stressed too that joint replacement is in high demand because it is one of the most efficient and cost effective means of improving quality of life.
Doug Robertson, a 43-year-old Toronto businessman who had a double hip replacement three years ago, could not agree more.
"I got to the point where I was in constant throbbing pain," he said. "Now I don't even think about my hips. It's an unbelievable difference."
Mr. Robertson suffers from osteoarthritis, which is caused by the break down and loss of cartilage in the joints.
Traditionally seen as a disease of aging - cartilage wears down over time like rubber on car tires - osteoarthritis increasingly affects younger people who are overweight. Genetics also play a role and there is a common belief - the subject of scientific debate - that vigorous exercise can also cause arthritis.
Mr. Robertson, who played squash seven days a week and competed in triathlons, believes that is the source of his joint problems.
The Canadian Institute for Health Information data show that while the vast majority of patients undergoing joint replacement have good results, about one in seven patients are readmitted to hospital within a year.
Kathleen Morris, a consultant in the research and analysis branch of CIHI, said that it is important to keep those numbers in context and to realize only a small proportion of hospitalization is directly related to complications of surgery - which include infections, dislocation or loosening of the prosthetic.
Only in about 1 per cent of cases are there severe complications such as a deep joint infection that requires that the procedure be redone.
While this is a good success rate, Dr. Dunbar said, it should also serve as a reminder of the dangers of hospital-based infections.
"Joint replacement is an ultra-sterile procedure," he said. "We can't afford to let our guard down."
Mary Kim, a 47-year-old resident of Toronto, has undergone joint replacement procedures annually since 2000 (two hips, two knees, two shoulders and an elbow). "People keep saying I'm a bionic woman. I wish."
While the joint replacements have all gone well and vastly improved her life, Ms. Kim has suffered from a recurring infection in the months since her latest knee replacement.
It is unclear whether the infection was due to surgery or her underlying condition (rheumatoid arthritis, an autoimmune disease that causes joint inflammation) but it may prevent her from having other joint replacements.
Ms. Kim, who had her first surgery in 1990, said the technology is remarkably better today and, as a result, it's much easier to bounce back.
"Everything is better now: the prosthesis, the anesthesia, the surgery. I used to spend eight weeks in hospital after surgery. Now it's down to a week," she said.
"People don't know how good they have it today."
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Hip replacement surgery
Should the hip joint become deteriorated or damaged, its components can be replaced to relieve pain and improve mobility.
1- A reamer is used to remove cartilage and smooth the acetabulum (hip socket).
2-The head of the femur is removed and the thigh bone is hollowed out.
3-The new acetabular prosthesis is a bowl-like piece of metal with a plastic or ceramic liner.
4-A prosthetic stem is inserted into the hollow bone, then a metal or ceramic ball is attached to replace the head of the femur.
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