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Surgeons ask exercising baby boomers not to abuse their new knees

Posted: Friday, March 08, 2002

WASHINGTON (AP) -- Exercising baby boomers must realize new knees are not like new tires: You can't just wear out one set and buy another.

Active, middle-aged patients with arthritic knees should try switching to lower-impact activities before deciding on surgical replacement of the joint, orthopedic surgeons say. If they have surgery, patients should realize that tennis, basketball and a daily run may be out afterward.

What to do with patients who insist on doing things they love, even if it endangers compromised joints, was the subject of a presentation at the American Academy of Orthopaedic Surgeons' annual meeting in Dallas in February.

''People are healthier and more active into their 60s, and they expect to be more active,'' said Dr. Arlen Hanssen of the Mayo Clinic, Rochester, Minn., who moderated the program. ''You can't do everything, but a lot of people attempt that.''

The surgery often is done to relieve pain and improve joint movement that deteriorates due to osteoarthritis. In this condition, cartilage on the bone surfaces inside the joint wears away, and the leg bones rub against each other. Doctors take out the joint, and put in a metal-and-plastic replacement. The joint surfaces are cemented to the bones, or the bones are allowed to grow through mesh surfaces on the replacement.

Potential patients might avoid surgery by switching to activities that put less impact on their damaged joints, Hanssen said. This conservative approach could be the best alternative, potentially preserving their knees while letting them continue activity that is healthful for the rest of their bodies, he said.

Over 300,000 knee replacements are done each year, and most work out quite well, Hanssen said. But the first ones are the best, because each subsequent operation opens the possibility of more scarring and bone loss, he said.

About 95 percent of first-time knee patients think the results are good or excellent, but the percentage drops 10 percent to 15 percent with each subsequent operation, Hanssen said. The subsequent operations have higher risks of scarring that can lead to stiffness.

Sometimes, patients will be honest after knee replacement surgery, but sometimes not. ''It's hard to know who is doing what,'' Hanssen said. ''Some are very honest and will point-blank say, 'I'm still playing singles tennis.' Others, I believe they are not truthful. I've observed patients doing things I've told them not to.''

There are no reliable demographics on who will listen and who will not. But in Hanssen's experience, racquet sports players are among the more bullheaded. Tennis players don't want to give up something they see as part sport and part social activity, he said.

Aging athletes need to expand their horizons or change their patterns, or both, doctors say. The goal is to stay active and get the health benefits.

Dr. Nicholas Di Nubile of Haverton, Pa., team physician for the NBA's Philadelphia 76ers, recommends runners switch to biking, walking and using an elliptical trainer, a machine that uses a low-impact sliding motion.

Weight training can help to keep the knee stable by strengthening the muscles around it, Di Nubile said.

As for tennis, with its dashes and turns, players should at least substitute gentle doubles for tough singles, he recommended.

But not all doctors agree that boomers with artificial knees have to give up what they love. Dr. Norman Scott, chairman of orthopedics at Beth Israel Medical Center in New York, is one of them. ''We let people play tennis. We let the good skiers ski. I have people who were skaters. I let them skate,'' he said.

They may have to cut back, to engage in their sport for fun instead of conditioning, Scott said. But the pain of arthritis probably had made them cut back before they opted for knee replacement, he said. As for replacing the replacement, Scott noted that the odds that the patient will leave very happy with the results drop with each subsequent operation. However, ''there is nothing people can do to destroy their knees so much that we can't put a replacement in,'' he said.

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On the Net:

AAOS exercise guide: http://orthoinfo.aaos.org/booklet/thr--report.cfm?thread--id16&topcat egory

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