HEALTH Boomers get new hips and knees

More people in their 40s and 50s are having hip and knee replacements.
NEW YORK (AP) -- When she felt a dull ache in her left hip 3 1/2 years ago, Sarah Jane Francis knew instantly what lay ahead.
Osteoarthritis had forced her to have her right hip replaced in 1998 and doctors warned that her left hip would most likely meet the same fate. Eventually, the ache progressed to a constant throb that even a double dose of her pain medication didn't stop. She couldn't walk around the block, and even had to ask her husband to shave her legs.
"I just couldn't bend over anymore," said the 47-year Dallas homemaker, who had the operation last month. "It was time."
Advancements in surgery and prostheses combined with a dearth of medicines for osteoarthritis are nudging doctors to perform more hip and knee replacements on baby boomers. Although the procedures are still mostly performed on people over 65, a growing number of boomers, who range from 38 to 56, are getting implants.
Statistics
According to the American Academy of Orthopaedic Surgeons, baby boomers had 35,000 hip replacements or 21 percent of the procedures in 2001, the last year for which figures are available. That's up from 16 percent of all procedures in 1997.
Likewise, boomers had 48,000 knee replacements or 15 percent of the total 2001, up from 12 percent in 1997.
Doctors estimate that over 90 percent of joint replacements are done because of osteoarthritis, which affects nearly 21 million people and is the most common form of arthritis. Osteoarthritis is a degenerative disease characterized by the breakdown of a joint's cartilage, and is caused by a variety of factors including injuries, obesity and genetics. The breakdown causes bones to rub against each other, resulting in pain and loss of movement.
The incidence of arthritis increases as people age. In 1997, the Centers for Disease Control and Prevention estimated 43 million Americans suffered with arthritis, up from 37.9 million in 1990.
Downside of lifestyle
Doctors say baby boomers seem to have arthritis symptoms at a younger age than previous generations, probably because of their active lifestyles. With a motto of "no pain, no gain," boomers have embraced jogging, aerobics, skiing and other activities.
"This is a generation that played hard," said Dr. Nicholas A. DiNubile, an orthopedic surgeon in Havertown, Pa. "Their parents didn't play sports. They didn't get early injuries."
A decade or so ago, doctors and patients chose to put off implants as long as possible because prostheses would last only about 10 years and replacement surgery becomes less effective and more dangerous each time it is done. Now prostheses are expected to last 25 years, so doctors are more willing to give them to younger patients.
The problem with giving boomers new hips and knees, doctors say, is convincing them to adjust active lifestyles that may have contributed to the need for surgery.
"You have to tell the patients all the time that these are not the joints that God gave you," said Dr. Frank Kelly, an orthopedic surgeon in Macon, Ga. "I tell them in person, I show them videos, I write it down. I hope they listen."
A study released last year showed that patients who opted to postpone joint replacement surgery the longest had more pain and less mobility than patients who didn't wait. The 222 patients in the study were in their 60s and 70s, but there are implications for boomers too, said its author, Dr. Jeffrey Katz, an assistant professor of rheumatology at Brigham and Women's Hospital in Boston.
"I think the medical profession held patients back from this surgery," Katz said. And while he doesn't advocate arthritis patients' undergoing surgery right away, he said the study should encourage doctors and patients not to wait until pain is unbearable.