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The number of knee replacements done annually in the U.S. will jump 525% by
2030. You read correctly: 525%. This prediction comes out of a paper presented Thursday at the annual meeting of the American Academy of Orthopaedic Surgeons. Hip replacements? Those will more than double, rising from 285,000 to 573,000. And the money spent on these procedures
is expected to reach $65.2 billion by 2015, putting a huge burden on
federal Medicare and Medicaid programs, which pay for about 60% of U.S.
It's no surprise that Americans are turning toward
these operations joint replacement has spared millions of older adults
from spending their older years in a wheelchair. "We have a perfect
storm of an aging population, increased demands by younger patients, a
better ability to do the procedure, and increased arthritis in the
general population," says Dr. Richard Iorio, a senior orthopedic surgeon
at the Lahey Clinic Medical Center in Burlington, Mass., and lead author
of the paper. Painful osteoarthritis, he explains, is responsible for
the vast majority of joint replacement surgery.
There's another factor
contributing to the epidemic of failing joints: obesity. The obese, says
Iorio, have twice the rate of hip and knee arthritis as adults with a
healthy body weight. Nearly 32% of obese adults have arthritis, as
opposed to 16% of those of normal weight and 22% of people who are
overweight but not obese.
Iorio says that average age at which Americans seek joint replacements
has been gradually creeping down. "In my own practice," he says, "it
used to be about 70 years of age, and now it's about 65." With better-lasting implants and better surgical techniques, he observes, "people
are much less reluctant to jump in." Changing attitudes will likely
accelerate this trend. "Baby boomers want to be active and they are not
willing to accept disability, so they seek out surgery earlier than
their parents did."
Future patients may, however, be stymied by a shortage of skilled
surgeons. The supply of orthopedic surgeons will increase only 2%
between 2000 and 2020, despite soaring demand for their services.
Patients with more complicated cases, requiring the attention of a joint
replacement specialist, could really be in trouble, according to an
analysis by Iorio and his co-authors. They found that only 6% to 7% of
orthopedic surgeons are specializing in joint replacement. A plummeting
reimbursement rate for this kind of surgery it's dropped about 39% in
recent years, according to the paper makes this kind of work "pretty
unappealing to younger surgeons," says Dr. Iorio.
While many people are genetically prone to develop arthritis as they
age, there are steps individuals can take to reduce the odds that they
will become part of the joint replacement epidemic. Weight control is
paramount, says Dr. Joseph Buckwalter, an arthritis specialist at the
University of Iowa Medical Center. "For someone who is obese, even
losing a relatively little amount 15 to 20 lbs. can make a huge
difference, both in terms of pain and progression of the disease." For
every pound of weight lost, you can take 3 to 5 lbs. of force off a bad
joint. Lose 10 pounds, and that's 30 to 50 fewer pounds of force.
Joint injuries earlier life even in childhood tend to set people up for
arthritis, especially if the injuries aren't treated correctly. "Even a
bad ankle sprain could raise the risk of osteoarthritis," says
Buckwalter. He therefore advises getting the best possible care after
injuring a joint. This can be as basic as resting and icing a sprained
ankle or knee and then resuming activity gradually and carefully,
starting out with physical therapy, if necessary. "If you have joint injury, make sure
that you select activities that don't increase risk. You want to avoid
repetitive twisting and pounding."
A third major thing people can do, says Buckwalter, is exercise to
maintain muscle strength, range of motion and flexibility, all of which
protects the joints. "You need to look at taking care of a vulnerable
joint the way you take care of your teeth," he says. Ideally, that means
stretching and strengthening muscles on a daily basis. "When my patients
say, 'I can't do that,'" he says, "I say, well, you brush your teeth