March 10, 2012

USA: Joint replacement gives seniors leg up on activity, longevity

SACRAMENTO, California / The Sacramento Bee / March 10, 2012

By Anita Creamer

A lifetime of wear and tear on his joints caused Dick Pryor, a 77-year-old retired landscape architect, to undergo not one but two surgeries to replace his knees.
Neither slowed him down for long.
Dick Pryor, 77, has had both knees replaced but that hasn't 
diminished his time on the ski slopes. The retired landscape 
architect also walks every day to stay in shape as part 
of his campaign to continue skiing until he's at least 85. 
Manny Crisostomo
"With one knee replacement, I was back skiing three months later," said Pryor, a Sacramento resident who began skiing a half-century ago. "I could have gone skiing sooner, but the snow wasn't any good."  Like Pryor, many of his 130 fellow members of the local 49er Ski Club – average age 72 – have dealt with chronic knee and hip problems, and many remain athletically active after joint replacement surgery.
Pryor also walks every day to stay in shape. Bill Anthony, 83, a retired Roseville family physician who had both hips replaced and, most recently, recovered from a broken back, likes to bike three times a week and lift weights when he's not skiing.
"And we kayak in the summer," said Anthony.
"We also do a lot of hiking," said ski group member Judy Agid, 73, a hip replacement veteran and retired Sacramento State fencing coach who has hiked hundreds of miles through Spain and biked across America twice.
While that level of activity might sound unusual, experts on aging say it hints at a new norm. For more energetic seniors today, knee and hip replacements provide a break from vigorous physical activity, not the end of it.
In part, that's because older adults have learned a key lesson: They expect to maintain a good quality of life, because they know that age does not equal infirmity and illness.
"I'd say that age is irrelevant," said Pat Beal, 74, Senior Center of Elk Grove executive director.
"We have drivers for our Dial-A-Ride program who have hip replacements and can't wait to get back to volunteering. They tell me how many weeks they'll be out, and I have to tell them to take their time recovering.
"Seniors recognize that life is short, and they don't want to take more time away from what they enjoy. They want to get on with life and have fun while they can."
Increasingly, that quality of life doesn't include enduring the aches and pains of joint problems caused by osteoarthritis or previous injuries.
Well before the tidal wave of the baby boom generation began hitting retirement age, the number of hip and knee replacement procedures more than doubled between 1996 and 2007, according to the National Center for Health Statistics.
Today, Americans undergo more than 1 million of these knee and hip procedures each year, and a growing number are performed on people in their 50s and 60s.
For example, almost 5 percent of people ages 50 and older have had knee replacement surgery, the American Academy of Orthopaedic Surgeons says – and so have 10 percent of people 80 and older.
"A lot of our older people are trying to keep going and stay active until their maker calls them," said Dr. Stephen Howell, a Methodist Hospital orthopedic surgeon who performs 420 knee replacement procedures each year.
"I always tell people you only go around once. My father is 88, and he's got two knee replacements. He swims laps every day. He plays golf. He still lives independently. Without having his knees done, he'd be in a nursing home now."
Mobility issues and the debilitating level of pain associated with chronic joint problems are two of the major reasons an estimated 210,000 elderly Californians reside in the state's short- and long-term care facilities.
Joint replacement procedures can make living independently in old age possible for many people. And research indicates it can make life itself possible, as well. According to a 12-year study of 135,000 Medicare patients, those who underwent knee replacement surgery had half the risk of dying within the next seven years as patients who opted against the procedure.
It's an interesting equation that encompasses a lot of life beyond achy hips and knees: Joint replacement surgery enhances older adults' chances of remaining physically active. In turn, being active not only helps mitigate difficulties with balance and falling, it also reduces the likelihood that seniors will become homebound and isolated, leading to a potentially deadly cascade of problems.
"Everybody can be active at different levels," said Lisa Cirill, who leads the state Department of Public Health's California Active Communities program. "It's crucial that they are."
In a real way, staying mobile – being at least able to walk, if not run and bike and ski – prolongs lives.
"One of the doctors I went to told me, 'You're getting older, and you're doing too much,' " said Agid. "So I changed doctors."
She's still going strong. So is Bill Anthony, who likes to tell people that he met a group of really elderly skiers at Mammoth a few years back – people in their 90s.
And so is Dick Pryor, who recently changed his goal of skiing until he hits age 80: Now, he said, he's going to keep going to at least 85.
"These are people who raise the expectations of other people," said Howell. "It's very encouraging. We all do our part to mentor by example and to let other people know these things are possible."
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