A ‘tidal wave’ of middle-class sportsmen and women who want to continue playing tennis and running into their 60s is putting pressure on the NHS with a 20 per cent rise in knee replacement surgery expected within ten years, it has emerged.
Pictures of David Cameron out jogging before work, London mayor Boris Johnson cycling to the office and Barack Obama playing basketball and working out in the gym are encouraging a generation of middle-aged workers to continue with sports, a surgeon has said.
The ‘social cache’ associated with being fit and sporty into middle age has fuelled an increase in knee surgery as the joint becomes worn out, it was warned.
David Barrett, an orthopaedic surgeon at Southampton General Hospital, said across the country there is a trend for more people in their 40s and 50 needing knee surgery as a result of being sporty for longer and also refusing to ‘hang up their boots’ when they sustain an injury.
“Sport has adapted to this trend, there are veterans football leagues and triathlons are divided into age groups. It reflects an entirely new approach to life and the NHS is going to have to get its head around it,” Mr Barrett said.
He said there are currently 70,000 knee replacements carried out in England on the NHS every year and this is expected to rise by 20 per cent in the next five to ten years, mostly among the younger age groups.
Primary Care Trusts have delayed patients needing hip and knee replacements by offering them physiotherapy instead as a way of saving money, it has been alleged.
A knee replacement costs the NHS around £7,600.
Competitive sport has been taken to new heights in recent years, Mr Barrett said, and now it is not enough to have completed one marathon, you have to collect them by doing London, New York and Chicago, or do 50 mile extreme marathons in deserts or seven in seven days, he said.
“We have become defined by our sport and it is taking its toll on our joints,” Mr Barrett said.
More than a third of his patients are what Mr Barrett has called ‘weekend warriors’ who are in their 40s and 50s having suffered knee injuries through sport and he is even seeing the same patient come back time and again for repeated surgery.
Skiing, tennis, triathlons, running, and football are the major sports responsible for the injuries.
He has developed a new knee operation, involving resurfacing part of the joint in a less invasive alternative to a total replacement, specifically for younger patients.
“We were putting knees for 75 year-olds in 50-year-olds. It is like expecting sport’s car performance from a family saloon and it wasn’t appropriate to their needs,” he said.
The standard knee replacement joints are large and ‘clunky’ and while the offer adequate mobility for a man in his 70s or 80s they are not acceptable for someone in their 40s who still goes out jogging and skis, Mr Barrett said.
The newer knee operation is less invasive, meaning patients are in hospital for two or three days instead of six or seven and can be back on the golf course in 12 weeks.
The technique, known as bicompartmental knee resurfacing, involves replacing only the areas of cartilage affected by wear and tear and avoids removal of the ligaments, enabling more natural movement immediately after surgery.
Traditional replacement surgery requires a large incision, removal of all four ligaments and full replacement of the joint regardless of the extent of damage.
However, using resurfacing, only the ligament on the inside of the knee and the kneecap are affected when a surgeon removes sections of damaged cartilage and replaces it with plastic or alloy metal implants.
The operation is around 20 per cent cheaper than a full replacement however questions have been asked if the NHS should be paying for it at all.
Mr Barrett said: ” We could say that for a chap not being able to play golf but who can still get to his desk, why should the NHS shell out for surgery?
“I want to give my patients the knee that is most appropriate to their requirements but that is a conversation the NHS will have to have.”
Health Minister Simon Burns said: “With more people in their 40s and 50s keeping active the NHS will face increasing demand for knee operations in future years. So it’s excellent news that with this new operation we can extend the lifespan of people’s knees and halve their recovery time from knee operations.
“New and innovative practices, especially those led by clinicians, are essential and have a vital role to play if the NHS is to become more productive and improve results for patients.
By Rebecca Smith, Medical Editor
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