SAN DIEGO — We’re becoming a nation of bum knees, worn-out hips and sore shoulders, and it’s not just the Medicare set. Baby- boomer bones and joints also are taking a pounding, spawning a boom in operations to fix them.
Knee-replacement surgeries have doubled in the past decade and more than tripled in the 45-to-64 age group, new research shows. Hips are trending that way too.
And here’s a surprise: It’s not all because of obesity. Ironically, trying to stay fit and avoid extra pounds is taking a toll on a generation that expects bad joints to be swapped out like old tires on a car.
“Boomeritis” or “fix-me-itis” is what Dr. Nicholas DiNubile, a suburban Philadelphia surgeon, calls it.
“It’s this mind-set of ‘fix me at any cost; turn back the clock,’ ” said DiNubile, an adviser to several pro athletic groups and a spokesman for the American Academy of Orthopaedic Surgeons. “The boomers are the first generation trying to stay active in droves on an aging frame” and are less willing to use a cane or put up with pain or stiffness as their grandparents did, he said.
A huge industry says they don’t have to. TV ads show people water skiing with new hips. Ads tout “the athletic knee,” “the custom knee,” “the male knee,” “the female knee.”
Tennis great Billie Jean King, 67, is promoting the “30-year” Smith & Nephew knees she got last year.
Joint replacements have enabled millions of people like King to lead better lives, and surgeons are increasingly comfortable offering them to younger people.
But here’s the rub: No one real ly knows how well these implants will perform in the active baby boomers who are getting them now. Most studies were done in older folks whose expectations were to be able to go watch a grandchild’s soccer game — not play the sport themselves, as one researcher put it.
Even the studies presented at a recent orthopedics conference that found knee replacements are lasting 20 years come with the caveat that this is in older people who were not stressing their new joints by running marathons, skiing or playing tennis.
Besides the usual risks of surgery — infection, blood clots, anesthesia problems — replacing joints in younger people increases the chances they’ll need future operations when these wear out, specialists say.
“We think very carefully about patients under 50” and talk many of them out of replacing joints, said Dr. William Robb, orthopedics chief at NorthShore University HealthSystem in suburban Chicago.
But many don’t want to wait, even if they’re not much beyond that: Karen Cornwall, a Havertown, Pa., nurse, had both knees replaced last year when she was 54.
“I just felt like I was too young and too active to be in pain all the time,” she said.
People are urged to exercise because it’s so important for health, but there are “too many wannabes” who overdo it by trying to imitate elite athletes, said Dr. Norman Schachar, a surgeon and assistant dean at the University of Calgary in Alberta, Canada.
“They think if they’ve got a sore knee, they’re entitled to having it replaced,” he said. “I think surgeons are overdoing it too, to try to meet that expectation.”
Dr. Ronald Hillock, an orthopedic surgeon in Las Vegas, sees the demand from patients.
“People come in and say, ‘This is what I want; this is what I need,’ ” he said. “They could buy a cane or wear a brace,” but most want a surgical fix.
The numbers tell the story. There were 288,471 total hip replacements in 2009, nearly half of them in people younger than 65, according to the federal Agency for Healthcare Research and Quality, which tracks hospitalizations.
Knee replacements soared from 264,311 in 1997 to 621,029 in 2009, and more than tripled among 45- to 64-year-olds.
“Five or 10 years ago, a very small number of people under 65 were receiving this surgery. Now we see more and more younger people getting it,” said Elena Losina, co-director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital in Boston.
She analyzed how much of the rise resulted from population growth and obesity, and presented results at an orthopedic meeting in San Diego in February.
From 1997 to 2007, the population of 45- to 64-year-olds grew by 36 percent, but knee replacements in this group more than tripled. Obesity rates didn’t rise enough to explain the trend.
“At most, 23 percent of the 10-year growth in total knee replacement can be explained by increasing obesity and population size,” Losina said.
What the experts recommend
•Cross training. People tend to find one thing they like and do it a lot, but multiple activities prevent overuse.
•Balance your routines to build strength, flexibility, core muscles and cardiovascular health.
•Lose weight. “Every extra pound you carry registers as five extra pounds on your knees,” said Dr. Nicholas DiNubile, a surgeon and spokesman for the American Academy of Orthopaedic Surgeons. “The good news is, you don’t need to lose a lot of weight” to ease the burden.
•Spend more time warming up. Break a sweat and get the blood flowing before you go full blast.
•Let muscles and joints recover and rest in between workouts.
•If you’ve had a joint replacement, do the physical therapy that’s recommended. “I tell patients 20 percent of the outcome is the technical stuff I do in the surgery and 80 percent is them,” said Dr. Ronald Hillock, a Las Vegas orthopedic surgeon. “I can do a perfect surgery, but if they don’t do the rehab they’re not going to have a good outcome.”
