New Hip, No Problem!

You might remember I talked with Joe Namath recently about his book, “All The Way.” During some small talk in our conversation, I mentioned I had my hip replaced at the end of last year.

“I’ve had both knees and a hip,” Joe responded. “They’re great. Do the rehab. Those cats know what they’re talking about.”

Namath had celebrated knee problems during his career but three joint replacements? Apparently these days, that’s not unusual.

Ten-time Grand Slam tennis champion Tony Trabert also has two artificial knees and a new hip. He had his knees replaced two months apart twenty years ago.

“I haven’t had one ounce of problem with any of them, I don’t even think about it, Just do the rehab.” Trabert explained.

Former Jaguars offensive tackle Tony Boselli has had both hips replaced.

“Best thing I ever did,” he said.

Namath is 77 years old. Trabert is 90 and Boselli is 48. All are former professional athletes who used their bodies in extraordinary ways. It wouldn’t be unusual to think they put undue wear and tear on their joints as part of their professions.

But it’s not just professional athletes who are choosing to get new knees, hips and shoulders. In 2020, an estimated 1.1 million people in the US will have a joint replaced. That number is expected to nearly double in the next twenty years. More women, 62%, than men have joint replacements and although the average age is creeping down each year, 95% of the patients are 45 and older. It’s the number one elective surgery, by far, in the US and the UK.

“Baby Boomers, no question, “ Dr. John Redmond of Southeast Orthopedic Specialists said when asked about the fastest growing population of people needing joint replacement. Redmond has seen research that says the number of people who will elect to have joint replacements could triple to over three million by 2030.

“Ten years ago If somebody who came in for joint replacement was under 50 we told them there was a 40% chance of it wearing out in 20 years,” Redmond explained. “There’s a new plastic that we use now and some ceramics. The failure rate now is far less than 5%. Somebody comes in now at 50 years old, I can say I’m pretty confident it’s going to last the rest of your life.”

“There are so many ideal candidates coming in these days,” agreed local orthopedic surgeon Dr. Paul Shirley also of SE Orthopedic.

“Baby boomers are coming in to continue an active lifestyle. When it hurts, people have to give up a level of participation that they still enjoy. They don’t want to do that.”

Shirley completed his first joint replacement as an assistant in Gainesville in 1972 to Dr. John Charnley, the British surgeon who pioneered the modern hip replacement procedure. A lot has happened in medicine since then.

“I wasn’t particularly interested in that,” Shirley said. “I wanted to do more arthroscopy and do preventative. At the time there wasn’t anything that lasted more than ten years. Now with all of the scientific advancements, the new metallurgy and materials, using computers. They get it perfect and reduce the stresses, they could last 30 years or more.”

Medical experts have seen a generation of people being active into adulthood for the first time, not just as school kids or into their 20’s and 30’s. That leads to injuries and arthritic damage. There’s also a change in the expectation people have of their activity level into their 50’s and beyond.

Former Georgia, NFL and USFL quarterback Matt Robinson, who turned 65 in June, is having his knee replaced this month after limping around for several years.

“I held on as long as I could,” Matt said of his lingering knee problems from his football career. “It’s having a negative effect on the active lifestyle I want to have. I want to hunt, fish, scuba dive. I want to keep active.”

Surgeons agree that playing sports, especially professional sports, takes a toll on your body,

When he originally saw the surgeon Matt was told, “Your knee is terrible.”

“I was hoping for a more clinical diagnosis,” he said with a laugh. “So he said, ‘Ok, your knee is horrible.’”

Robinson added that his knee pain had kept him away from staying in the kind of physical condition he’d like

“I stayed away from the weight room and other stuff because I didn’t want to make my knee any worse than it is,” he explained,

Weight gain in America also seems to be playing a role. Fifty-four percent of hip patients and 79% of knee patients have a body mass index greater than 30. In other words, they’re considered obese.

“It’s like putting one ton of stuff in a half ton pickup,” said Dr. Steve Lucie a 40-year veteran of orthopedic surgery, currently with Jacksonville Orthopedic Institute.

“The weight hastens the deterioration of the joints by overloading them. If you could lose a little weight before getting a replacement done, that makes it a lot better.”

We’re lucky in North Florida to have so many options to choose from when it comes to joint replacement. Between Southeast Orthopedic, Jacksonville Orthopedic Institute, the Mayo Clinic and others, some of the best orthopedic surgeons in the world are right here in our backyard.

“Because of the training programs in town at UF Health, Nemours and Mayo, Jacksonville is a bio-medical hotspot,” said Dr. Steve Lancaster who recently retired from JOI after nearly forty years as an orthopedic surgeon.

“The improvement is in technology and techniques like using robotics.” Lucie explained. “It allows us to make the replacement be more balanced, more precise. That’s what we’re hoping makes patients knees back closer to what their expectations are. Plus, the pain management is so much better.”

“If I see x-rays of a knee replacement I did five years ago it’s not near as precise as what we’re doing now,” Dr. Redmond agreed.. “I use robotics for 100% for my knee procedures now. It’s almost routine that the knee looks perfect. Inherently there’s human error, but with the robotics we don’t rely on our eyeballs as much as the machine.”

All of this expertise and advancements in technology comes at a price. Joint replacements are generally covered by insurance and can run between $70-$100K. With the number of procedures being done, it’s big business.

“The nature of a surgical practice is doing stuff,” Dr. Lancaster added. “We don’t get paid to not due stuff. Athletes destroy their knees, shoulders and hips and that’s when they come to us to consider surgical options.”

When you factor in all of the different people, hospital staff and procedures necessary to complete a joint replacement, the numbers add up.

“I get calls from patients asking about paying for lab results, the pathologist, the x-rays,” Lancaster explained. “Patients wonder why they’re paying all these different people.”

“Medicare is driving the numbers,” he added. “Whatever number they’ll pay for is where the dollar number is for the doctors. The average here in town is probably about $2K for a procedure for the surgeon.”

Nonetheless, choosing to get a joint replaced rather than limp around is now nearly routine.

“Surgeons are getting more confident,” Redmond added. “If you take a look at quality of life between 50 and 60, it’s generally higher than between 70 and 80. To tell a patient to live with a bad hip for ten years now is bad advice.”

“More and more people are doing well,” Lancaster agreed. “Even with higher expectations. We would have never have considered putting anything in somebody under fifty fifteen years ago.”

And Redmond said patient expectations are very high.

“I saw an 80 year-old woman yesterday who said she wants to get this fixed as soon as possible because she wants to play tennis every day.”