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Posted: April 14, 2009

Battle of wounded knees

Baby boomers aching to stay active are fueling a bonanza for the sports medicine business – and a strain on health-care costs

Lisa Marshall

At age 44, cyclist Scott England has endured no less than 10 surgeries on his knee, shoulder and toes. He goes to physical therapy twice a week, has weekly pain-numbing injections in his joints, and even owns his own ultrasound machine.

Runner Kathy Gebhardt, 51, is on “volume 3” of her medical file, with five knee operations behind her and a total joint replacement looking inevitable.

Competitive rower Dr. Richard Flanigan, 70, is already sporting the scars where doctors replaced his worn-out hip and knee with brand new ones.

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Scott England goes through his daily workout at home in Boulder.

But ask any one of these active Colorado baby boomers to give up their sport, and they’ll tell you straight up: not a chance. “We’re seeing sports injuries in people in their late 40s and 50s that we used to see only in high school, college or professional athletes,” says Dr. Ted Parks, chief of staff at the Colorado Orthopaedic and Surgical Hospital, a new Denver facility specializing exclusively in orthopedics. “Forty-five-, 55-, and even 65-year-olds are out there playing and competing, and when they get hurt they want to get fixed and back to the game ASAP.”

In fact, the nation’s baby boomers suffered more than 567,000 sports injuries in 2007, according to the Centers for Disease Control, flooding hospital emergency rooms, orthopedic surgeons’ offices, and sports medicine clinics in unprecedented numbers. Raised on Jane Fonda aerobics and a “No Pain No Gain” mentality, many of the 78 million Americans born between 1946 and 1964 are greeting middle-age with a vigor far exceeding what their parents exhibited at their age. Consequently, they’ve spawned a multibillion dollar industry of braces, orthotics, and shots, new surgical techniques and devices, and specialty hospitals and clinics aimed at keeping them in the game and fixing them when they break.

But the phenomenon, playfully dubbed “Boomeritis,” also has its downsides. As more svelte fiftysomething  runners file in for ACL repairs and joint replacements, will there be enough doctors to perform them? And as athletic boomers sign up for another MRI, physical therapy session, or exotic pain-killing injection, who will pay for it all?

“They don’t take no for an answer, and they have really high expectations of what we can do for them,” says Dr. Nicholas DiNubile, a Philadelphia-area orthopedic surgeon who coined the term “Boomeritis” and the accompanying “fix-me-itis” in the mid 1990s. “I see a lot of these boomers with an almost unlimited ability to consume health-care resources to get what they want. As a result, I fear our health-care system will be bankrupt before its time.”

The numbers

Concern about Boomeritis and its economic implications first arose in 2000 with a report from the U.S. Consumer Product Safety Commission. Sports-related injuries among baby boomers had increased an alarming 33 percent from 1991 to 1998, costing $18.7 billion in 1998 alone. Cycling and basketball topped the list for sending boomers to the emergency room, but injuries from running, weightlifting and swimming were also sharply rising. Since then, as those same boomers have tried to maintain their activity level despite years of overuse and mounting arthritis, the numbers have soared even further, making sports injuries the No. 2 reason that people visit the doctor.

“Prior generations just thought you get older and you get frail and your body fails,” DiNubile says. “Boomers are the first generation that is trying to stay active, in droves, on an aging frame.”

The first parts to go on that frame are often the joints, and the number of boomers, young and old, opting for a trade-in has skyrocketed. Nationwide, according to the American Academy of Orthopaedic Surgeons, 229,000 people had total hip replacements in 2006 (up from 202,000 in 2003), while 497,000 had total knee replacements (up from 380,000 in 2003), and 20,000 had total shoulder replacements.  (Experts note that a rise in obesity, which weighs down on the joints, has also contributed to the increase.)

In ultra-fit Colorado, the number of total joint replacements in all three categories more than doubled between 1997 and 2006,  with more than 4,200 hip replacements, 8,500 knee replacements and 600 shoulder replacements in 2006. Those numbers don’t count the rising number of “revisions” – the surgery that occurs when the first replacement joint wears out and a second replacement must be done.

And, according to a report released in February at the annual meeting of the AAOS, demand for joint replacement is expected to double in the next 10 years, with the fastest growing group of patients in the age 45 to 54 category.
“It used to be that joint replacements were only considered for the elderly. Now half are going to younger patients,” says study author Steven Kurtz, corporate vice president of scientific consulting firm Exponent Inc. “People are living a more demanding, active life and they are not willing to compromise or wait.”

The trend has been a gold mine for companies like Stryker, a Michigan-based orthopedic implant company with strong Colorado roots. In January, Stryker reported its eighth consecutive year of double-digit sales growth, with sales of implants up nearly 11 percent and overall net sales at $6.7 billion.

Meanwhile, those hoping to avoid a joint replacement have fueled a boom in sports medicine.

“The baby boomers and their beat-up skeletons have driven a whole new industry,” says Andy Pruitt, who founded the Boulder Center for Sports Medicine in 1995. “There are new medical journals and organizations, injectable lubricants for knees, high-tech braces, and new minimally invasive surgical techniques all aimed at them.”

Pruitt recalls that in 1985, when he floated the idea of a sports medicine clinic for regular folks in Boulder “nobody was interested.” But a decade later, as the first wave of boomer athletes began to hobble in, the need became apparent and the Boulder Center for Sports Medicine was born.

Today, it boasts 20,000 square feet, two locations and 60 employees, and Pruitt’s schedule is filled not just with appointments with elite competitors but also with 60-year-olds having their knees scoped so they can keep skiing bumps, and 70-year-olds having Rooster Comb shots so they can make that next marathon. 

 “Andy, a long time ago, tried to get me to stop running,” says Gebhardt, 51, an avid trail runner who has been seeing Pruitt for a decade. “But he knows that it keeps me calmer and happier – that it is such a huge part of me enjoying my life – so he does what he can to keep me going.”

Other clear beneficiaries of the Boomeritis epidemic have been the makers of braces.

“Boomers have played a huge role in our success,” says Steve Willard, Colorado territory manager for DonJoy Orthopedics, a pioneer in the custom knee-brace business. The San Diego-based company, founded by Philadelphia Eagles player Mark Nordquist in 1978, now boasts roughly $500 million in annual sales, catering primarily to the roughly 10 million Americans who suffer osteoarthritis of the knee. “It’s a huge market.”

Orthopedic specialists have also gotten busier, as they find themselves doing some surgeries, like joint replacements, far earlier in patient’s lives and doing others, like ACL repairs, far later.

“Twenty years ago, few middle-aged patients were active enough to tear their ACLs, and when they did, we rarely recommended reconstructive surgery,” Parks says. “A 45-year-old just didn’t need a performance knee. But that’s all changed.”

Today, doctors like him find themselves scheduling surgeries around races, and winding up on the speed dial of baby boomer patients.

“I got a call two Saturdays ago from a patient. She’d dislocated her shoulder trying to do an aerial somersault on a snowboard and she wanted surgery ASAP because she needed to be in tip-top shape for the Ironman triathlon in Hawaii this fall,” Parks says, noting that he assumed, after the call, that she was in her early 30s. “I drove in to meet her in the emergency room, and it turned out she was 58 years old.”

But all those shots and surgeries come at a price, and some fear we have yet to see the consequences. In 2004, the national hospital bill for hip and knee replacements alone was $26 billion, according to research by the Robert Stempel School of Public Health in Miami. And as demand for such surgeries increases, and health-care dollars become more scarce, many fear that patients will be asked to pay more out of pocket – or do without – and doctors will be forced to accept less and less reimbursement from private insurers and Medicare.

According to another study presented in February at the AAOS meeting, by 2016, 46 percent of needed hip replacements and 72 percent of needed knee replacements will not be completed. “Patients younger than 65 are generally paid for by private insurance, not Medicare, and what are the trends in private insurance? Less coverage, bigger deductibles,” Kurtz says. “The younger candidates are facing the prospect of paying more out of pocket, while the other half is paid by your taxes and my taxes. It’s not clear how much longer government can pay, and if they keep decreasing reimbursement, it is questionable whether or not doctors will want to do this procedure.”

In hopes of helping to fend off that seemingly inevitable meltdown, DiNubile wrote a book, “Framework: Your Seven Step Program for Healthy Muscles, Bones and Joints,” (Rodale, 2005) to teach active baby boomers how to better preserve that aging frame while remaining active. He touts cross-training and stretching, consistent year-round activity (rather than just rising from the couch to ski bumps each winter) and learning the humility to accept injuries and safely work around them.

Meanwhile, Parks has taken a novel approach to his practice, joining a team of 26 local orthopedic specialists to buy into the new physician-owned Colorado Orthopaedic and Surgical Hospital, a $50-million, 75,000-square-foot specialty hospital built and staffed specifically with orthopedic injuries in mind.

He says that by specializing in one thing, the hospital can improve patient care. And by owning part of the hospital, the doctors working there have more control over how it is run, how the profits are spent, and perhaps someday, a chance of making money from their shares.

But even if today’s active boomers do end up sucking resources from the health-care system in pursuit of immortal knees, rotator cuffs and cartilage, isn’t it better than paying for a generation plagued by heart disease, diabetes, and the other side effects of sedentary life?

Maybe so, DiNubile says: “If you rounded up all these baby boomers and told them to stay home on the couch, we’d have a lot more health problems to deal with.”

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