Fit for life More patients choosing joint replacement surgery to keep active

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November 3, 2008 — You could say Barry Glinski’s a new man.

In retirement he has taken on the hitting coach responsibilities for the Worcester Tornadoes after a career as a college coach, athletic director and math professor.

It wasn’t easy on a knee that caused constant pain, but a joint replacement two years ago has him using a fungo bat for only one reason: to hit balls to position players on the baseball field, not to lean on to hide his constant pain. Osteoarthritis had eroded the cartilage that used to cushion his knee joint, making him a candidate for knee replacement if he wanted to continue his active life.

And he did. Now it doesn’t hurt to cross a baseball diamond. He can comfortably swing a golf club and go fly fishing.

“I was able to do things I wasn’t able to do before in a span of about two months,” he said recently. “I was walking twice as far as I ever did. I was very pleased.”

Mr. Glinski, 66, is back in the swing of things, like other older adults taking advantage of improvements in materials and techniques used to repair orthopedic problems. Surgeries including total joint replacement of aching knees, hips, wrists, and shoulders have surged among younger patients, fueling an explosion in procedures over the last 10 years. Knee replacements alone grew 69 percent, according to the Agency for Healthcare Research and Quality, and hip replacements grew by 32 percent.

Patients in their 50s made up much of that growth. Instead of waiting past retirement age for a joint replacement that might be the only one they get, baby boomers have opted for earlier operations as implants’ longevity has climbed past 20 years, according to the American College of Rheumatology.

The boom among these working-age adults, though, is matched by a similar uptick among seniors in their 60s, 70s and beyond. They, too, are unwilling to resign themselves to the rocking chair when arthritis or other conditions hobble their joints and muscles.

“I think among 70-year-olds two generations ago, many of them would not entertain going through a major elective operation so they could do just a little bit more,” said Dr. William B. Balcom, an orthopedic surgeon who specializes in knee and hip replacements at Fallon Clinic, where he is vice chairman of orthopedics and on the staff of the Musculoskeletal Care Center at St. Vincent Hospital. “These days they clearly do.”

The materials used to make joint replacements have become more durable at the same time that surgery has gotten easier on the patient. Arthroscopic procedures using minimally invasive tools make a dramatic difference over older, open surgeries, but even joint replacement incisions have gotten smaller.

While 15 or 20 years ago surgeons were taught to make an incision that allowed a wide exposure of the area, today surgeons are taught to expose only as much as they need to see properly and no more, Dr. Balcom said. Newer surgical instruments help surgeons make smaller incisions, about half as wide as before, but still 20 percent larger than the implant that will replace the joint in question.

“We have heightened respect now for trying to minimize surgical trauma,” Dr. Balcom said.

Not all problems require joint replacement or other surgery to solve them, but procedures to repair wrists, elbows and shoulders hurt by carpal tunnel syndrome, tennis elbow or rotator cuff tears can help people get their active lives back, said Dr. William J. Morgan, chairman of orthopedic surgery at Fallon Clinic and also part of the Musculoskeletal Care Center at St. Vincent.

“These people don’t want to just do a little swimming,” he said. “They want to kayak, they want to ski, they want to enjoy retirement rather than working their whole lives and then being ill.”

Patients’ expectations have changed for what remains elective surgery. Dr. Balcom suggests that staying active is fundamental to both mental and physical health.

“These folks really do want and intend and prefer to stay active throughout their lives,” he said. “That requires adequate physical health to do things like golf or tennis or gardening. People have a much brighter outlook if they are able to do things they enjoy.”

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