As Baby Boomers age, Orthopedic Surgeons will see more demand

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As Baby Boomers Age, Orthopedic Surgeons Will See More Demand (written by Robin Williams Adams @ The Ledger – Lakeland, FL)

Aging baby boomers keep the market for knee and hip replacements strong, competitive and confusing.

“Baby boomers are getting to the age where their joints are wearing out,” said Dr. Marc Volpe, an orthopedic surgeon with Watson Clinic in Lakeland.

“As opposed to previous generations … they want to maintain a level of function that’s higher than their predecessors at older ages.”

And, as various studies have shown, baby boomers often don’t like waiting around.

“They tell me they’re fed up with the symptoms,” Volpe said.

Osteoarthritis, the main reason the cartilage in joints disappears and pain occurs, is more common in older adults, which baby boomers reluctantly are becoming.

Added to that, trauma injuries increase the likelihood people will develop arthritis at an earlier age, said Dr. Todd Hall of Lakeland Regional Orthopedic Associates.

Extra weight also increases the impact on the joints. Some medical analysts say the high number of overweight people in the United States is another reason for increasing numbers of joint replacement surgeries.

Anecdotally, Watson Clinic’s Dr. Phuc Vo sees the impact of obesity in his practice.

“Patients on whom I replace the hips now are much more obese than when I started (in Lakeland),” Vo said.

Hall and Vo also are orthopedic surgeons.

Local orthopedic surgeons face increased competition from surgeons outside Polk County who reach out to potential Polk patients.

Methods such as partial knee replacement, around for years, sometimes are presented as new developments. Manufacturers continually offer new or redesigned products.

Options are continuing to expand, however, such as differing approaches to surgery or competing ways of getting a clearer picture of individual knees and hips. The difficulty for physicians lies in distinguishing true advances from hype and advertising pitches, particularly when some of the marketing is directed at patients.

“It’s one of the hardest jobs for me, to assess all these innovations and select out what I think is the best for a specific patient,” said Vo, who also does sports medicine and other orthopedics.

He did the second-highest number of hip and knee replacements in Polk County, 228, in 2009-10, according to state records.

Dr. Samuel Messieh at Heart of Florida Regional Medical Center, whose focus is joint replacements, did the most with 496.

Patients choosing an orthopedic surgeon for joint replacement surgery should look for one who does a minimum 25 cases a year of the type of surgery needed, said Dr. Easwaran Balasubramanian of Temple University School of Medicine in Philadelphia.

The surgeon’s volume of cases is more important than the total number of those surgeries done at a hospital, Balasubramanian said.

Robotics, used more and more in cancer and urology treatments, isn’t an issue in joint replacement surgeries.

When it comes to visualizing the interior of the joint, however, or trying different methods intended to make surgery more exact or shorter, varying techniques have strong advocates.

Computer-assisted or computer-navigation surgery is one of them. Another is­patient specific instrumentation, a different way of determining where to make the surgical cuts required.

Hall said computer navigation allows more precision.

In computer navigation, surgeons attach infrared sensors to the bone. A computer calculates the sensors’ location, which Hall said makes it easier to plan and to accurately align the cutting devices used to install implants.

“We don’t need to wait for post-surgery X-rays to see our results,” Hall said.

Volpe, who also uses computer navigation, agrees it helps identify the anatomy of the joint.

He’s more enthusiastic, however, about patient specific instrumentation, an outgrowth of computer navigation.

Using magnetic resonance imaging, the orthopedic surgeon can measure the anatomy and shape of the knee, as well as its alignment to the leg.

That data is sent to a company that sends back a suggestion of which size or type of artificial joint appears more appropriate, as well as a disposable “cutting block” designed by using the patient-specific details.

With that model, orthopedic surgeons can spend less time planning during surgery because the navigation plan can be drawn up ahead of time.

It takes him more time overall, Volpe said, because he’s doing a mock surgery in advance of the real one.

Vo said studies indicate computer navigation is most helpful to orthopedic surgeons doing fewer than 25 cases a year.

Although he doesn’t consider it necessary for every patient, Vo said, there are specific patients for whom he finds it beneficial.

Patients’ differing lifestyles and physical condition influence the timing of replacement surgeries and the types of materials used in their implants. They need to have candid conversations with their orthopedic surgeons prior to surgery.

“The patient should talk to the orthopedist and present his or her side of the story,” Vo said. “What is it that drives them to need a joint replacement, and what kind of lifestyle they have, what they want to use the joint for.”

[ Robin Williams Adams can be reached atrobin.adams@theledger.com or 863-802-7558. ]

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