Over 40? Say Ouch
You're working hard to stay fit, and therein lies the problem.
By Jane Bennett Clark, Senior Associate Editor
From Kiplinger's Personal Finance magazine, January 2007
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Some conditions, such as a rotator-cuff tear, may have you slogging through rehab for several months. In those cases, "cortisone injections can be very helpful," says Dr. Roland Moskowitz, a professor of medicine at Case Western Reserve University School of Medicine, in Cleveland. Corticosteroids eliminate pain for weeks or months, allowing you to supercharge your regimen.
In recent years, doctors have added hyaluronic-acid therapy, also known as viscosupplementation, to their quiver of strategies. Injected into the knee joint, viscosupplements relieve the symptoms of osteoarthritis by boosting the thick, slippery substance that lubricates and cushions the joint. Viscosupplements are approved only for knees but, says Stitik, "we're hoping that relatively soon, the Food and Drug Administration will approve them for hip osteoarthritis."
Time for a trade-in
Dan Briscoe, of Downers Grove, Ill., played basketball, racquetball, golf and tennis until osteoarthritis in both hips slowed him down. "It started in my early forties," says Briscoe, now 50. "I was in a lot of pain. I felt like I was 70." Three years ago, he underwent hip-replacement surgery at Rush University Medical Center; his other hip was replaced last January.
Not long ago, conventional wisdom held that a 50-year-old was too young for joint-replacement surgery. Doctors hesitated to install a device that could wear out in ten or 15 years. Now, with longer-lasting materials and improved techniques, "it's not uncommon for me to operate on people in their forties and even thirties," says Berger. New-model implants for hips and knees -- the most common replacements -- can last up to 25 years.
No matter how old (or young) you are, you face replacement surgery if osteoarthritis has progressed so far that your bones have begun to erode. A surgeon may, however, be able to forestall replacement with arthroscopic surgery. In that procedure, the doctor uses instruments that look inside the joint and clean out loose bone or trim cartilage. "When arthritis is in its very early stages, some cartilage flakes off or gets a little torn, which can be painful. Arthroscopy smoothes cartilage out," says Berger. Surgeons also use the procedure to repair tendons and ligaments.
On paper, joint-replacement procedures seem like a simple construction project, with tools including a power drill, a mallet and screws. The surgeon makes an incision, removes the damaged bone or cartilage, smoothes the surface of the remaining bones and inserts the artificial joint. Then the surgeon applies bone cement or uses a cementless procedure to keep it in place. Weight-bearing materials, such as stainless steel, titanium and ceramics, are used for hip implants, along with heavy-duty plastic. Knee implants, which require flexibility, rely mostly on plastics.
With traditional replacement surgery, you spend several days in the hospital and at least six weeks rebuilding with a physical therapist. If your job requires that you stay on your feet or do any lifting, you could be off work twice as long. As a salesman for Hewlett-Packard, says Briscoe, "I couldn't be out of commission for six weeks." He discovered minimally invasive surgery, in which doctors use a muscle-sparing incision to insert the implant. "Recovery takes weeks, not months," says Berger, who developed the technique.
Briscoe was back at work part-time after two weeks. Now he is playing golf again and walks 2.5 miles a day, but has no plans to "push it," he says. Most surgeons recommend modifying your activities after replacement surgery -- say, by swimming rather than running or by using a treadmill instead of a track. Briscoe, who figures he has regained 90% of his range of motion, says, "I'm not going to do splits, but I'm very satisfied. I have all the mobility I need."
Advanced technology
Advances in technology, including minimally invasive surgery, have improved once-arduous surgeries, such as repairing the anterior cruciate ligament, or ACL. "We now do an incision that's less than an inch long," says Dr. Nicholas DiNubile. "Instead of being in a cast or a brace, you put weight on it right away." Soon, says DiNubile, researchers hope not only to replace but also to regenerate new parts, such as the ACL and rotator cuff. Surgeons already use cell transplants to create a collagen patch for knee repair. "The technology in orthopedics is unbelievable," says DiNubile, who wrote FrameWork (Rodale, $18), about keeping your frame in shape.