Joan Beck remembers when the pain in her right knee was so sharp that walking from her car to the house hurt. Her knee ached so much it kept her up at night. The longtime runner knew she could no longer hit the road. She'd had enough.

So at age 52 the Omahan underwent knee replacement surgery because she didn't want to give up her job teaching fitness classes or activities like golfing, swimming or tubing behind a boat.

“I wasn't ready to turn in the towel,” she said.

Once thought of as a procedure for old people, joint replacement has become more common among those in their late 40s, 50s and early 60s.

The trend is driven in part by the aging baby boom generation, but it's not just because the group is so large. Surgeons say boomers are used to staying active and don't want to live with a limp or use a cane when they're only 50 or 60.

“With the older generations it was more acceptable that as you get older you slow down,” said Dr. Charles Burt of Nebraska Orthopaedic Hospital. “As a generation, (boomers) don't want to slow down.”

Rising obesity rates also play a role. Heavier people put more wear and tear on joints, leading to the need for replacement at a younger age, said Dr. Michael Marks of the American Academy of Orthopaedic Surgeons.

And improved high-tech plastics make artificial joints more durable, enabling patients to return with more success to biking, gardening and other activities, he said.

But patients undergoing joint replacement at younger ages face a potential drawback. Even though materials have gotten better, artificial joints still wear out. That means a 50-year-old might require another replacement at age 70, and those second surgeries can leave patients more prone to infections and other complications.

Doctors say it's essential for patients to try nonsurgical options before getting joint replacement: weight loss, physical therapy, injections that lubricate joints and drugs that reduce swelling.

Beck, now 54, is a former marathon runner. She experienced twinges of pain and soreness in her knee in her 30s and 40s.

But after a marathon seven years ago, the pain became sharper and more persistent. Getting out of bed caused pain. So did getting up from a chair.

The pain was bad enough that she thought she might have torn a ligament in her knee, so she made an appointment with Burt, of the orthopaedic hospital.

Nothing was torn. Burt diagnosed her with osteoarthritis. Pain develops when cartilage, which cushions bones, wears down over time.

A person's genetics, as well as high-impact sports like running, can cause the cartilage to wear down faster than normal.

Beck's father and other relatives had knee problems, so she believes that genetics played a role. But she thinks the problem mostly was caused by the pounding from more than two decades of running and more than 30 years of teaching high-impact aerobics and other exercises.

Beck has had multiple sclerosis for more than 10 years and has mild symptoms such as fatigue, but Burt said the condition did not play a role in her knee problems.

He told her to stop running marathons. He also advised her to hold off on knee replacement until she took other steps to address the pain and swelling.

For the next five years she wore a knee brace when she exercised or taught fitness classes. She took over-the-counter medications to reduce swelling in her knee. She took injections to lubricate her knee joint. She underwent a procedure that removed bits of loose cartilage in her knee joint to reduce the pain.

Those steps helped some, she said, but overall the pain continued and worsened, even during day-to-day activities like driving her car. Stepping on the gas pedal hurt.

Beck, director of group fitness at Prairie Life Fitness at 84th and Q Streets, underwent her knee replacement in 2009 at Nebraska Orthopaedic.

The Omaha hospital performed 239 total joint replacements for patients under age 65 last year, up 68 percent from 2005.

Other hospitals and health systems reporting a growing number of joint replacements among younger patients include Alegent Health and Mercy Medical Center in Des Moines.

Nationally, federal figures show that the number of total hip replacements among people ages 45 through 64 grew from an estimated 68,000 in 2002 to about 111,000 in 2008, an increase of 63 percent. Knee replacement also increased significantly during that period.

In Nebraska the average hospital charge is $44,000 for a total hip replacement and $41,000 for a total knee. Joint replacement is covered by insurance.

Recovery time for a hip or knee replacement can range from three to six weeks, including physical therapy, before a person could leave the house and go for a short walk or drive a car, Burt said.

Within six months after surgery patients can resume most activities, although the recovery can be longer for some knee replacement patients.

Patients who end up requiring a second joint replacement face greater risks of blood clots, infection and other complications, partly because the surgery takes longer, said Dr. Craig Mahoney, co-director of the joint replacement center at Mercy Medical Center in Des Moines.

A second joint sometimes does not allow patients the same movement they had with the first one, he said.

But those problems must be weighed against the downside of waiting years to replace a joint, he said. Patients living with pain often become sedentary, which can lead to weight gain, heart disease and other problems.

Dr. Kevin Garvin, an orthopedic surgeon at the Nebraska Medical Center, said it's difficult to know how long the new generation of joints made with better materials will last.

Data indicate that older model joints could last 20 years for 80 percent of patients, said Garvin, chairman of orthopedic surgery at the University of Nebraska Medical Center.

Doctors think the newer joints will last longer, but there is no solid evidence yet, he said. Running and other high-impact activities can affect how long the new joints last, just as with the older model ones.

That's why he tells his patients it's OK to cycle, swim and play doubles tennis. But patients should skip basketball, running and other activities that pound their joints.

Beck's doctor gave her the same order. For exercise she rides a stationary bike and walks. At Prairie Life, she teaches classes gentle on the joints such as water aerobics.

She realizes that even though she's taking it easy she still might need a second joint someday, but she doesn't worry about it.

“I'm just happy about what I can do now,” she said.

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