The Replacements
The hip bone’s connected to the leg bone, the leg bone’s connected to the knee bone …
By Lisa Baker

“So much has been done, exclaimed the soul of Frankenstein — more, far more, will I achieve; treading in the steps already marked, I will pioneer a new way … ”
Mary Shelley’s “Frankenstein”

In 1818, advances in industry were on the rise and Mary Shelley spun her cautionary tale about the horrors of technology run amok.

It hasn’t been that long since technology was viewed with suspicion; now, we can’t get out of bed without it. In the morning, the coffeemaker automatically begins perking at 6 a.m. in a dark kitchen in the absence of human hands and, as it turns out, in the absence of actual coffee beans.

Computers begin updating themselves before the dawn, scanning for enemy viruses and welcoming the newest round of male enhancement products to your email inbox.

Your Blackberry sounds your alarm, its illuminated face doing the job of a personal assistant, or any mother: Get out of bed, slacker.

The sprinkler system shoots into action as you reach your driveway. Your car’s rearview camera system assures you that there are no unsupervised toddlers behind you, but there is a recycling container.

On the way to the office, your cell phone rings with an automated message from the library: Your seven-day fiction is three days overdue.

It is just the beginning of a day full of tech.

In the 1970s, there were lofty dreams for the miracles tech could bring. “The $6 Million Man” made people wonder if they could be made better, stronger, faster. But at the dawn of 2008, as baby boomers feel the painful effects of age stealing over them, they have a more modest goal:

Make us the way we were before.

In the vehicle vernacular, baby boomers have voluntarily and gleefully driven their bodies harder, further, and over more figurative off-road miles than their parents, extending what might have been short-term fitness fads into lifetime habits.

Some of those 1970s joggers are still on the road; the Datsun B210 is not.

While some baby boomers, to be sure, prefer to delegate landscaping tasks to professionals, many more are crawling about their yards supporting — with their Visa cards — the local nurseries and garden stores. While some are watching The Golf Channel, many are hitting the links themselves or, even better, hiking around the Himalayas. Some of this excess of activity is fueled by early retirement, which has given career-oriented Oregonians a chance to explore their hobbies and challenge the staying power of their bodies.

The result is an odd dichotomy: While active baby boomers enjoy healthier hearts than the earlier generation, their joints, like old shocks, are shot to ribbons. Pounding the pavement, it turns out, reduces the knees and hips to dust well before the time their owners planned to hang up their warm-ups.

Boomers have not been satisfied to adopt sedentary lifestyles, have not cottoned much to the game of bridge or pinochle. No, instead, they’re demanding replacement parts in such numbers that orthopedists find themselves overrun.

In 1998, some 266,000 new knees were installed. In 2005, just seven years later, nearly 534,000 were implanted, according to the American Academy of Orthopaedic Surgeons (AAOS). Partial hip replacements nearly doubled in that time and total hip jobs went from 160,000 to 234,000.

So, what makes a person decide to opt for replacement parts?

Nothing short of the promise of new life, or, at least, the return of the old one. That’s what it was for Kathy Holboke, of Portland, whose years charging down ski slopes and playing volleyball several days a week caught up to her at age 50, right when early retirement from her job in the insurance field made it possible to devote more time to her passions. Knee pain put the kibosh on nearly all of her favorite things. No more volleyball, no more skiing, very little gardening. Mundane tasks — even climbing the stairs — became problematic.

She tried the usual menu of options for joint-pain sufferers, but watched her pain increase gradually over five years through anti-inflamatory medications, arthroscopic surgery and finally, daily pain medications. “I got to where everything hurt — walking, sleeping, climbing stairs, getting up and down from gardening, the shift of weight in my golf swing. I kept doing it, of course, but when I got to the point where I was relying on pain medication just to get through 18 holes, the writing was on the wall.”

Holboke had a choice. She could, as others have, resign herself to her new limitations. But her vision of retirement, especially now that her husband had joined her in retirement, was an active one. “We wanted to travel, we wanted to hit golf courses everywhere. I’m a master gardener, and I had these dreams of improving the yard,” she says.

And so, the traditional laid-back lifestyle — one that her parents before her had chosen — was not an option. “I love my parents, but I wouldn’t trade lifestyles with them,” she says. “I love that I’m in such good shape.” She’d been watching other active friends delay joint replacement, watched how their lives became more restricted. “I have one friend who is looking for a tech breakthrough in stem cells so she won’t have to do knee replacement. Another one is waiting until he’s 60, but in the meantime, his life is miserable. Their world keeps getting smaller, and they keep having to make more compromises,” she says. “I knew what I wanted. I wanted my life back.”

At the end of December, a month after knee replacement surgery, Holboke says she is sure she made the right decision.

This, after all, was not the dreaded laid-up-for-weeks-on-end ordeal that such surgeries have been in the past. She started walking within hours of her surgery, insisting on trying to make it all the way to the nurse’s station rather than just to her hospital room door as the nurse had suggested. “I’m a competitive personality,” she explains. But her first outing was not without trepidation. “I expected it to feel like something foreign, like a robot knee, and thinking about it gave me the heebies,” she says. “The idea that there would be something fake in my body that is a part you use all the time. In the end, there is a little popping and cracking that’s different, but you can’t tell where the fake stops and my bone begins — it really surprised me.”

Weeks later, still working heavily on her physical therapy, she says it’s all been worth it, if she can just go back to her active life.

Doctors say it’s a decision that’s getting easier for patients now that replacement parts for hips and knees are better and smoother and the techniques for installing them have improved.

Incisions are smaller, hospital stays shorter, durability longer.

The success of the surgeries is one thing that’s driving demand, says Dr. Paul Duwelius, Holboke’s surgeon, an orthopedist at Portland’s Orthopedic & Fracture Clinic. “I have a pretty big database of people who are very happy. This is a great surgery with a lot of patient satisfaction.”

One of the reasons: “We have more options,” says Duwelius. “Before, we had maybe 10 options. Now, there are 60 different ones and we can do a better job of matching a patient’s anatomy with a particular (joint) product for a better fit. The patient has better range of motion, which basically means they can do more stuff.”

One new product: the Gender Solutions High Flex Knee, the first knee replacement created just for women.

Skip Priest, director of business development for the northwest office of Zimmer Inc., the company behind the product, says researchers discovered anatomical differences between knees in men and women — not in size, but in shape. The new product, he says, addresses those differences and provides Zimmer with a potential marketing advantage, if surgeons find it effective, because so many women experience knee problems as they age. “Almost 60 percent of people getting knees today are women. The fact is, women are more prone to knee problems than men,” Priest said.

William Strassberg, spokesman for the AAOS and himself a joint replacement surgeon, says his organization expects the number of replacement procedures to jump to 1 million by 2030 “because they add so much quality of life to people who would otherwise experience pain around the clock and have to give up activities.”

While Strassberg describes joint surgery in reassuring terms, he concedes that there are aspects of the procedures that might make some patients uneasy.

BNW: So, we understand that the surgery involves pounding and hammering.

Strassberg: Well ... It’s a highly precise surgery where we remove the diseased joint surfaces and very carefully sculpt the ends …

BNW: So, you cut out the old bone and then use the hammer.

Strassberg: Well, there are points in the shaping of it and in the, uh, placement of these surface caps that some power tools are utilized …

BNW: There are power tools involved?

Strassberg: Well, there is some use of pneumatic equipment in the sculpting process of the bone, and then to really fit the caps, we will use an instrument to impact them.

BNW: So, you pound them with a hammer.

Strassberg: Well, it’s a procedure that is mating the joints … I suppose you could say it’s like hammering, but ultimately, it’s mating the joints. The art is in balancing it right so it is well aligned.

Which is to say, there is good reason for the anesthetic.

But in the end, thanks to minimally invasive methods, little of the muscle tissue is disturbed, which means recovery is faster, Strassberg says.

The best part, Duwelius says, is being able to tell patients that they can “go back and do what they wanted to do before.”

Of course, that doesn’t mean there aren’t limitations to man-made joints, whether knees or hips. “I tell them if they want to run, they can run to get out of harm’s way,” Duwelius says. “If they’re a coach, they can run onto the field.”

A marathon runner? Well, there’s always cycling.

For Holboke, who is not a marathon runner, the prognosis could not be better.

“I’m definitely starting to think golf,” she says. “And I’m looking in the garden and thinking about what am I going do here and there. If I can garden all day pain free, I will think I’ve died and gone to heaven.”

BrainstormNW - January 2008

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