by Eric Marcotte, MD

Associated Press health writer Marilynn Marchione recently reported on the rapid growth of so-called “fix-me-it is” in orthopedic surgery.  Healthier and younger than the typical patients undergoing joint replacement, Baby Boomers are driving the next big wave of joint replacements in medicine.

This is definitely welcome news for Zimmer, Biomet, and our other fine biomedical companies here in Indiana.   Whether this is good news for the Baby Boomers in 20-30 years remains to be seen.

One difficulty with this shift is that joint replacement surgery has always been intended to return the elderly to a more mobile state or to relieve pain or both.  For Baby Boomers it is instead a lifestyle choice allowing participating members of society to stay active at far higher levels than the previous generation would have dreamed.

This is obviously an immediate good for the individual Baby Boomer and certainly a boon for the implant makers and surgeons.  Is it an unmitigated good?  That’s a little more difficult to determine.

First, I worry that it may be problematic for these people in the future.  The best of these implants is currently rated for approximately 30 years of use.  Commentators are already pointing out that this estimate is based on the use patterns of sedentary elderly patients.  Whether active people like former tennis star Billie Jean King will get the same duration of service from her double knee implants remains an open question.

Any orthopedic surgeon can tell you how difficult it is to replace a replacement. As a doctor I fear that we are going to have a lot of unhappy people needing re-replacements in the middle future.

Second, I wonder about the impact en masse knee replacements for fifty-somethings will have both now and in the future for society as a whole.  Collectively, we must balance the value of having our middle-aged, most productive citizens able to enjoy a higher activity level against the high financial and health costs incurred both now and in the future.  Replacing and re-replacing joints will certainly not be financially inexpensive.  As a doctor who has seen the gamut of things that go can wrong after joint replacement, I think the human cost will not be inexpensive either.  Blood clots, infections, cement failures, skipped therapy, the list goes on.

Deciding what is likely best for any one patient is daunting enough.  What is best for us all?  That is a question far beyond this humble blogger’s skills.  Apparently it is also beyond Congress’ ability since no one seems willing or able to make the difficult choices that are incumbent upon us.

The better question is what those of us who do not yet need a knee or hip or shoulder replacement can do to avoid having this conversation with our family doctor in the future.  As one of the doctors having these discussions, I can tell you that we really do not know the answer to the question of whether a 50-year-old should get a new knee.  What I do know is that a 40-year-old should take a heck of a lot better care of his or her knees so the conversation doesn’t need to happen at 50.

Keeping a healthy weight, keeping a healthy activity level, and making sure that diet and sleep are properly balanced will all go a long way towards making the joints we were born with last us a lot longer than they often do.

Eric Marcotte is a family physician who blogs at doctorfoodtruth.

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