How the hip replacement became the hot Gen-X surgery

So many people are getting hip replacements in their 40s or 50s that a remake of ‘The Breakfast Club’ would be set in a physical therapy facility

Hip replacements are no longer for those over a certain age.Maura Intemann

Not her. Beth Laliberty was only 54. A skier, a soccer player — a kid. Sure, she’d been limping for years. And yeah, when she caught sight of her reflection in a window at Market Basket in Haverhill she was shocked by the hunched figure leaning on the cart for support. “Who’s that 85-year-old woman?” she wondered.

But even so, when a surgeon suggested a hip replacement, Laliberty recoiled. “That’s for old people,” she thought.

Well, that’s how she felt two hips ago anyway. On a recent Wednesday – 11 years since the doctor’s unwelcome recommendation, and nearly five years since her new joints gave her her “life back” – Laliberty was still struggling to understand her former self.

“I don’t know if it was a vanity thing,” said Laliberty, an attorney in solo practice.

But guess what? Grandma surgery is no longer just for grandmas. In fact, so many people are getting hip replacements in their 40′s or 50′s that the procedure could become a new Gen-X merit badge.

If they remake “The Breakfast Club,” it should be set in a physical therapy facility.

The demographic shift toward younger patients can be seen in the data, on the operating table, and on orthopedic-focused websites, where headlines like this one from the Cleveland Clinic are today’s clickbait: “Are You ‘Too Young’ for Hip Replacement Surgery?” it asks. (Short answer: No.)

A widely quoted statistic comes from the National Hospital Discharge Survey, which looked at total hip replacements among inpatients aged 45 and older, and found that the greatest increase in the rate of the procedure was among the 45-54 group. Over the 11-year period covered by the survey (from 2000 to 2010, the most recent data available), the rate more than doubled, from 45 replacements per 100,000 people to 117 per 100,000.

In Boston, Atrius Health surgeon Georges Almacari is increasingly seeing younger patients at the New England Baptist Hospital and the other hospitals where he operates.

Half of his hip-replacement patients are now between the ages of 45 and 60, he said, a “dramatic” shift from when he started practicing in 2003, and the average age was between 67 and 75.

“Their body image is very important to them,” he said. “They say, ‘My wife is telling me I’m always limping. I cannot be limping in my office.’”

On TikTok, a video titled “total hip replacement vibes” and set to the viral song Heat Waves, has 2.5 million views. Look, there’s the youthful patient looking telegenic as she rises from a bed with the help of a walker, and uses crutches to walk down stairs.

What the heck is going on with our hips? Were earlier generations of middle-aged people hardier — willing to live with more pain? Is some kind of copy-cat situation going on?

Crucially, improvement in the surgical technique and implant materials over the past decade and a half or so means that total hip replacements are lasting longer.

In nine out of ten patients, the replaced hip is still functioning well after twenty years, compared with 10 to 15 years in the past, said Dr. Young-Min Kwon a hip and knee replacement surgeon and the vice chair of Department of Orthopaedic Surgery at Massachusetts General Hospital.

He emphasized that even in younger and more active patients — a group that used to wear out their replacement hips faster — recent data from the American Joint Replacement Registry shows that 99 percent of patients younger than 65 years have well-functioning total hip replacements after nearly a decade.

The longer-lasting replacement hips have led to a change in mindset: from holding out as long as possible so you won’t need to have a second procedure, to doing it when it becomes clear that less invasive remedies — physical therapy, topical or oral pain relievers, weight loss, cortisone injections — are not enough, said orthopedic surgeon Matthew Harb who is affiliated with Johns Hopkins Sibley Memorial Hospital and goes by @thebonesurgeon on Instagram.

Consider Anne Conlon, a 59-year-old senior operations associate at Morgan Stanley in Boston. She’s getting her left hip done in April, and was told by her surgeon that it would probably last her “lifetime.”

That was good news, she said, although it also made her focus on her mortality. “Realistically,” she said, laughing nervously, “the ‘rest of my life’ is not going to be super long,” she said. “It’s not like I’m 20.”

Hip replacements have also gotten more attractive for younger people as the procedure and hospital stays have gotten shorter. In some cases, patients don’t even spend the night. “It’s the way to feel young,” said a 62-year-old who’s having a hip replaced this spring, and was glad to hear from the intake coordinator that because of her age she’d likely be going home the same day. “At least I’m not 80.”

It’s not quite right to say that people are getting hip replacements because their friends are, but at the same time, it’s not quite wrong.

The more middle-aged people who get it, the more prospective patients and even primary care doctors will start to think of the procedure as something appropriate for the under-60 set, said Harb, but it’s still early enough that the hip replacement’s image has not yet changed, he said. “Medicine is slow-moving,” he said.

Meanwhile, even though it is generally easier to recover from an operation when you are younger, Almacari, the Atrius Health clinician, said it is not youth that determines how well someone does with their new hip, but rather their dedication to post-surgery physical therapy.

“Real estate agents are my best patients. They’re so motivated,” he said. “Especially in a good market.”