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Chad Ryan | The Journal Gazette
Dr. William Berghoff, anorthopedic surgeon with Ortho Northeast in Fort Wayne, holds a prosthetic knee joint.

Ortho procedures on rise

Aging boomers active, needing parts replaced


Even though it had been more than 10 years since I had my right hip surgically replaced, I recognized the old, familiar pain when the left one started flaring up about this time last year.

There was the searing sting in every step, which shot pain into the back, which caused me to walk hunched over. Handrails were a necessity in climbing stairs. A short walk was excruciating, leaving me breathless. A long walk was impossible, leaving me helpless. Finally, after a fall and winter of coping and Quasimodo-like posture, I had total left hip replacement surgery in mid-May.

Although I was less than three months away from turning 62, it was the third joint replacement procedure in over a dozen years, with the first one coming at age 50. The scoreboard reads hips 2, left knee 1. I've been told the right knee will eventually need attention.

So what's wrong?

The standard cavalier comeback was that everything resulted from an old football injury when I fell off the fan bus, which I didn't. It was just an attempt at gallows humor. The actual reason was osteoarthritis caused primarily from a bone disfiguration in which my joints were misaligned. A lifetime of playing sports accelerated deterioration.

As it turns out, I'm just one face in a very large crowd.

My baby boomer generation – the American population born between the years 1946 and 1964 – has caused knee and hip replacement surgeries to double and, in some age groups, triple over the past decade. And just as boomers refuse to slow down, the industry will continue on its torrid pace as the generation ages.

"It's this mindset of 'fix me at any cost, turn back the clock,' " Dr. Nicholas DiNubile, a suburban Philadelphia surgeon, tells The Associated Press. "The boomers are the first generation trying to stay active in droves on an aging frame."

In 2012 there were more than 285,000 hip replacement surgeries in the United States, according to the American Academy of Orthopedic Surgeons. That was a 25 percent increase over the previous five years. The same report showed that there were more than 600,000 knee replacement surgeries – a number that has doubled over the last decade and more than tripled in the 45-to-64 age group.

"A lot of that has to do with us changing," says Dr. William Berghoff, an orthopedic surgeon with Ortho Northeast in Fort Wayne who "did about 730" joint replacements last year. "I think there are two things that change: One, the makeup of the American today has changed dramatically in the last several years."

Berghoff said today's baby boomer generation is more active than their parents were at the same ages, and the "boomers" try to maintain the same active lifestyle.

"We like to be more active," Berghoff says. "I'm more active than my dad ever was.

"Maybe we have a few more injuries. Maybe they can cause arthritis. But maybe the flip side of that, too, is we like to stay active, so that if we start to have arthritis that's slowing us down, we're going to go in and have something done, versus maybe our parents would say, 'I'll just live with it with a couple aspirin and I'll be fine.' We don't accept that anymore as a culture. We try to make the most of what we have."

The other reason for the growth of joint replacements, Berghoff says, is the commonality and success rate of the surgeries.

"At one time, when I first started practice, about half the people who needed joint replacements in this country, in the 1990s, wouldn't come in to see a surgeon because of the horror stories that they heard in the '70s and '80s regarding having a joint replaced. People have more confidence," Berghoff says. "If you look at the recent numbers, there are about 45 to 50 million people in the country who have arthritis. … Eventually they're going to get to a point to where they need a joint replacement."

The AAOS reported that 4.5 million Americans have had at least one knee totally replaced, which is nearly 5 percent of the population age 50 and older.

Joey Meyer, former Mad Ants basketball coach and now a Midwest scout with the NBA Los Angeles Clippers, had a right hip replaced in April.

"I remember I went to the Ryder Cup (golf tournament)," said Meyer, 64. "It was the practice round, and I was walking downhill. Downhill has always been bad on my joints. And all of a sudden, it was so painful, that when I got back to the car, I couldn't get my hip in the car. That's when I decided I might have to have something done with this.

"It was bone-on-bone," he said.

It was the second replacement surgery for Meyer, who had his right ankle replaced in 2010.

"I was one of the early birds with the ankle," said Meyer, 64, who was a standout basketball guard at DePaul University in the late 1960s and early '70s under his legendary father, Ray Meyer, a member of the Basketball Hall of Fame.

When Meyer met with his orthopedic surgeon in Lincoln Park, Ill., to discuss getting his hip replaced, the doctor told Meyer that their relationship would probably not end with just one procedure.

"He told me in a few years, I'll be back," Meyer says. "He said to me that my other hip doesn't look real good. I'm going to have pain, but that's no big deal. I'm hoping no more."

While Meyer's surgical future remains tenuous, the future of the joint replacement industry remains on a steady incline – from the orthopedic engineers who design the devices to the manufactures that make and distribute them to the physicians who insert them.

What the patients are demanding is that their new hips and new knees will last the rest of their lives.

"I'm sure the boys in Warsaw (the orthopedic engineers from Warsaw-based manufacturers DePuy, Zimmer and Biomet) will tell you that the materials that these are made out of have changed dramatically in the last 20 years or so," Berghoff says. "When I first started in the early 1990s, we'd tell people the hip would last about 10 years because that was based on 1980s technology.

"All things considered, now, I think, if you take care of a joint – you do what the doctor tells you what you can and can't do – hip joints should last you 20, 25 years. A lot of them are made now so that some of the parts can be replaced without taking the whole hip out – just the plastic part, and the ball can be replaced, if everything else looks fine."

As the end of the calendar year nears, Berghoff knows his surgical workload will increase. It's like clockwork.

"Every year, toward the end of the year in Indiana and in the Midwest, you get inundated with people who want to get it done before the end of the year," Berghoff says.

By now, many have fulfilled their insurance deductible, so there is less out-of-pocket expense for a procedure that requires several days in a hospital and, particularly for knee replacement patients, extensive therapy.

Farmers have their crops in, and want to recuperate during the winter months. Avid golfers can recover before they tee it up in the spring.

"You will get people in December, when your schedule is just jammed for the rest of the year and you can't get another person on, who will come in and tell you this is going to cost them 5,600 bucks if I have to wait and do it next year," Berghoff says. "They're an average person, and that's real money for them. And I'll say, 'Fine, we'll do it. I'll put you on the cancellation list. If we don't get a cancellation, I will get you done before Christmas.'

"Most days I do between six and eight (surgeries). At the end of the year, I routinely do eight a day, but I will be doing 10 several days before the end of the year."

And as the baby boomers continue to age, the waiting list increases.

Replacement surgeries

Baby boomers have caused knee and hip replacement surgeries to increase over the past decade. Below is a breakdown of the number of surgeries by age group in the U.S. for the most recent three years for which data is available.

Total hip replacements
85 and older14,15114,24814,658
Total knee replacements
85 and older16,96017,39116,809
Source: American Academy of Orthopedic Surgeons