Why Knee And Hip Replacement Surgery Is On The Rise

Regular exercise boosts energy and cognitive skills, aids sleep, and enhances the ability to cope with stress. These benefits hinge on regular exercise; the boomers who tend to forget their body’s age while exercising or playing too rigorously, too often, may end up damaging hip and knee joints in particular.This activity and its ensuing injuries and joint damage have even brought about the coinage of a new term in the orthopedic world—“boomeritis”—created by Dr. Nicholas DeNubile, an orthopedic surgeon at the Hospital of the University of Penn.It’s the condition with which many middle- aged patients become afflicted when they’ve over-stressed their aging body parts to the point of requiring drastic treatments.

A few of the maladies diagnosed in association with boomeritis include tendinitis, bursitis, and arthritis—all conditions further exacerbated by continued activity if left untreated.Osteoarthritis, or degenerative joint disease, can be particularly debilitating and often requires replacement surgery. Until now, both knee and hip replacement surgeries used to be primarily associated with the Medicare population.That’s changing with boomeritis on the rise, according to an article by Dr. Matthew Boes, a Raleigh, N.C., sports medicine specialist. Over the last 10 years he says there was a threefold increase in knee replacements among the 45- to 64-year-old age span.Such statistics beg the question: How do you get the exercise required for maximum health and avoid trading in your human joints for manufactured ones?

Orthopedic surgeon Dr. Seth Baublitz, with Orthopaedic Specialists of Central PA, whose emphasis is on sports medicine/arthroscopic surgery, suggests that boomers be proactive in their approach to healthy joints by strengthening the muscles around the knee through low-impact fitness programs. He recommends avoiding most exercises that involve high impact and deep knee bending.“Walking,” he says, “is a simple exercise that has been shown to reduce pain associated with knee arthritis.”Biking, treadmill walking, using the elliptical machine, and swimming are also examples of low-impact exercise. A daily stretching routine that focuses on back, hips, knees, and calf muscles aids in maintaining greater flexibility to muscles and tendons that stiffen and “creak” with age and become more prone to injury.

If diagnosed with degenerative joint disease in the knee, several treatment strategies have been proven to alleviate pain and improve function, at least in the short term. Baublitz says that conservative alternatives are usually the first approach for arthritic knee pain. They include a combination of the following: patient education, weight loss, physical therapy, medications, and bracing.When these treatments are exhausted and the patient’s daily pain level affects quality of life, replacement surgery needs to be considered. Baublitz’s explanation for the rise in replacement surgery among boomers is this: “Knee arthritis can be extremely debilitating and interfere with even the basic activities of daily living. Rather than suffer with knee pain, baby boomers realize that a knee replacement typically relieves pain and facilitates a return to a healthy, active lifestyle.”He says that a return to athletic activities, such as golf, bowling, dancing, and bicycling, is very realistic; those that put stress on the knee—running, jumping, squatting—should be avoided. As far as postsurgical recovery, he says patients report “significant satisfaction in terms of pain relief around the nine- to 12-month timeframe.”

Dr. Raymond Dahl, a practicing partner of Orthopedic Institute of Pennsylvania, specializes in joint replacement and spinal surgery. Promoting preventative measures as the recipe for healthy living, he says that you can eliminate or at least put off the necessity for a knee or hip replacement by maintaining a healthy weight and exercising regularly.“The best exercise,” he says, “is low-impact aerobic activity for endurance, range of motion exercise to maintain flexibility, and strength/pain training for muscle tone.”Dahl also explains that the increase in hip and knee replacements for the boomer generation is the result of the 45-64 age group’s desire to be more active than any previous generations. Consequently, many of them continue to participate in sports and gym workouts with the same intensity they demonstrated in their 20s and 30s.“Rather than waiting,” Dahl says, “these patients are opting for hip and knee replacements at a much earlier onset of osteoarthritis to maintain their active lifestyle.” Dahl indicates that because of this, the total number of replacements performed each year is rising dramatically.Both hip and knee surgeries are executed to replace the weight-bearing surfaces of these joints. The surgeon cuts away damaged bone and cartilage and replaces it with an alloy of cobalt, chrome, or titanium and a plastic compound called polyethylene. Dahl says it’s the polyethylene that makes a difference in today’s joint replacement procedures, compared to 10 years ago; the new plastics are designed to comprise much better wear characteristics, which in turn improves the longevity of the prosthesis.“Unless you get an infection or have an accident,” says Dahl, “the longevity of the prosthesis is at 15 to 20 years. The first-year failure rate for total joint replacement is less than 1 percent.”Dahl adds that total hip replacement “is the best surgery we do, period. It has the highest satisfaction rate of all surgery and affords a less painful recovery than knee surgery.”

According to the American Academy of Orthopaedic Surgeons, “Hip replacement procedures have been found to result in significant restoration of function and reduction of pain in over 90 percent of patients.”Most hip and knee surgeries are for complete or total replacements versus partial replacements. That’s true for the knee, since it’s the largest joint and the most easily injured. Because it’s broken up into three compartments, it’s rare that only one compartment is diseased.Dahl says that the actual number for partial knee replacements is about 5 percent of all surgeries done. But for those 5 percent, the benefits include quicker recovery times, hospital stays, and rehabilitation.“Partial knee replacement,” says Baublitz, “is less invasive and requires minimal violation of the bone and soft tissue around the knee. Rehabilitation is usually accelerated, and patients often report that their replacement knee feels very much like their native knee.”However, he also notes that many patients who seek treatment for the pain caused by knee arthritis are not candidates for the less invasive surgery, since they exhibit more than one diseased knee compartment. Baublitz says that additional factors a surgeon must consider for partial knee replacement include the patient’s motion, stability, and degree of knee deformity.In the end, he says, “For reduction of pain and restoration of function, total knee replacement remains the gold standard for the treatment of knee osteoarthritis and pain involving all parts of the knee.”According to Dahl, a very narrow population may benefit from hip resurfacing—an alternative to total hip replacement for arthritis of the hip. He says that typical candidates for this procedure include younger (60 and under), thinner males. The advantage offered by this interim treatment is that it “preserves enough healthy bone to allow for future total hip replacement.”Ultimately, whether it’s through injury, excessive weight gain, osteoarthritis, or as a result of genetic factors, the degree of daily pain in either of your knees or hips will dictate your decision for replacement surgery.Joint replacement is “a surgery you ask for,” Dahl says. When your quality of life is so compromised by pain that even your sleep is disrupted, then you’re probably ready for it.

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