Better Health & Living
The Bionic You
Baby boomers are clamoring for surgery to replace worn-out knees and hips. Is that a good thing?
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Jan Lowrey, 54, earned her knee pain the hard way: It was a result of the basketball injuries she racked up in high school and college and during more than 20 years as a coach at both the college and professional levels. Four surgeries, spaced over four decades, hadn’t helped.
“I always managed to live with the pain, but by the time I hit my 40s, it became much more of a problem,” says Lowrey, who lives in Azle, Texas. “I used to run six miles a day, bike, and hike; when I couldn’t, I gained weight and became less and less active.” Worse, she says, was that all the pain began to drag on her emotionally as well. “I have lots of friends who travel and hike and bike and kayak, and I just felt myself not wanting to do anything,” she says.
When another injury forced her to spend a little time in a wheelchair, she knew she had to do something. “The first doctor I went to told me I was too young to have knee replacement surgery, but the next told me I should have both knees replaced, and soon. When he said, ‘Why should you miss out?’ that made sense to me.”
Lowrey is not alone. In 2005, the latest year for which data is available, 556,000 Americans had knee replacements, reports the Agency for Healthcare Research and Quality, which tracks surgical procedures in the United States. That’s up from 295,000 in 1993. Hip replacements are also on the rise, although not as quickly: 314,000 people got new hips in 2005, up from 294,000 in 1993.
90 percent of those who get total knee replacements report fast pain relief, more mobility, and improved quality of life.
While it’s still true that these procedures are usually performed on those old enough to remember the first Truman presidency, doctors say they are increasingly seeing patients in their 40s or 50s, as well as hard-charging athletic types who are even younger.
There are a number of reasons these relative youngsters are looking for more help with joint pain. “People are taller and heavier than they used to be, which means they get arthritis younger,” says Richard A. Berger, MD, who specializes in joint reconstruction at Chicago’s Rush University Medical Center. And there is less optimism about getting relief with medication since one drug, Vioxx, was pulled off the market due to concerns about cardiovascular problems, and a second, Celebrex, was also linked to heart risks. Plus, boomers have often spent more time on the athletic wild side, from downhill skiing to marathon racing, than previous generations, and they are less likely to suffer in silence.
Besides, everyone has heard miracle stories: According to the FDA, for example, about 90 percent of those who get total knee replacements report fast pain relief, more mobility, and improved quality of life. So who wouldn’t want to replace creaky, crunchy joints with spare parts that make you want to leap and frolic like a kid again?
Joint Replacement Basics
Experts worry that all those good outcomes are causing too many patients to push for what is still a risky procedure. At this point, 21 million people over the age of 25 have osteoarthritis. (While the word sounds geriatric, it simply means that the slippery cartilage that allows joints to function normally is breaking down, so bone begins to grate on bone. And although age is certainly a factor in this degenerative joint disease, so are genetics, being overweight, and previous injuries to the joint or ligaments.)
Of course, that doesn’t mean doctors will sharpen their scalpels 21 million times. Instead, surgery is usually reserved for patients who have exhausted other treatment measures—including medication, physical therapy, and alternative approaches such as acupuncture or meditation—and those who have significant pain.
For those who do elect to have joints replaced, the procedure is similar for both knees and hips. Doctors make a large incision—up to 12 inches—often through large muscles. Then they saw away the damaged ends of the bones and insert a prosthetic joint. Usually, it’s made of metal (titanium, cobalt, or chromium) or plastic (high-density polyethylene).
Recovery from such operations takes time and can be grueling. Lowrey, who had both knees replaced at once, is typical. “I couldn’t do anything for two or three weeks. I had to take lots of pain medications, which I hated. And the rehab process—going from a walker to two canes to one cane—was no fun. But by the time five months had gone by, I was able to say, ‘I’m glad I did them both at once.’ And by six months, I was able to go on a three-hour hike with no pain at all.”
Of course, doctors are constantly improving techniques, such as finding ways to make smaller incisions and damage less of the surrounding tissue, often sparing the large quadriceps muscle in the thigh.
Dr. Berger has pioneered outpatient joint replacement surgery that allows many patients to walk out of the hospital the same day they get a new hip or knee. “We’re able to do the surgery without cutting muscles, ligaments, or tendons,” he says. “Instead, we make small cuts in the bones, prepare the two ends of the bones, and then put the replacement in piece by piece. Not only do many patients walk out the door that same day with a cane, they are often back to work in a week.”
This approach is controversial, and only a small number of such minimally invasive surgeries are performed each year. Also, the jury is still out on whether these and other less invasive surgeries, which do result in faster healing, actually have better long-term results—or raise the risk of more surgical complications.
There are more cons. Although up to 95 percent of knee replacements last 15 years or longer, “there are still a certain number of patients who will have the joint fail or wear out,” says Mary O’Connor, MD, chair of orthopedic surgery at the Mayo Clinic in Jacksonville, Florida. “And that ‘revision’ surgery is more difficult and more risky.”
While joint replacement isn’t an easy decision, for some the operation can be life changing. “As rough as it was, I tell people, ‘Don’t hesitate—get it done now,‘“ says Lowrey. “I had the surgery at 53, and I wish I had done it at 50, or even 45!”
Frequent contributor Sarah Mahoney says she’s holding out for a total personality transplant.
Pick a Doctor by the Numbers
For a better outcome, ask prospective surgeons how many joint replacement surgeries they do a year. Researchers from Brigham and Women’s Hospital in Boston found that the risk of complications is highest among surgeons who performed fewer than 25 knee replacement surgeries per year and at hospitals that manage fewer than 25 such cases. Risks are lowest among surgeons and hospitals that handle at least 50 operations per year.
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