Not your grandma's surgery

Written by Katie Mills Giorgio

Photos by John Richard

Steve Gerard could be the poster boy for baby boomer hip replacement.

In June and July of last year, at the age of 56, Gerard — who is an associate judge in Iowa’s sixth district in Iowa City — had both of his hips replaced.

Two years earlier, he started experiencing pain that gradually intensified, so much so that it was limiting his physical activity. “I couldn’t even walk a block and it was waking me up at night,” he says.

That’s when he started thinking about hip replacement. But Gerard was told by doctors at University Hospitals that he was too young and that he ought to wait as long as he could before having the surgery.

“I was taking an incredible amount of ibuprofen, which was prescribed to me, but my stomach was hurting and it wasn’t helping with the pain,” Gerard says. “When I was finally unable to ride my bike I decided I was going to have to do something or I was going to have to be completely sedentary.”

That’s when he decided to get a second opinion.

“They looked at my X-rays and showed me how my hips had deteriorated in two years’ time. They told me this is purely elective surgery, that it’s major surgery and a big deal, but that if I wanted the procedure they would do it.” He says his doctors made no recommendation either way and left the decision up to him.

“I went home that night and talked to my wife. I called the next day and said ‘Put me on the schedule.’”

Gerard is not alone in his quest to relieve joint pain.

Some 500,000 knee replacements and more than 175,000 hip replacements are performed each year in the U.S. And according to a study presented at the American Academy of Orthopedic Surgeons’ 2006 annual meeting, those numbers are headed for an astonishing leap. Hip replacements are expected to increase 174 percent over the next 20 years, and knee replacements will increase by 673 percent over that same period, due in large part to an aging boomer generation that leads a very active lifestyle.

Dr. Charles Clark is the Dr. Michael Bonfiglio Professor of Orthopedic Surgery in the Carver College of Medicine and a professor of Biomedical Engineering in the College of Engineering, both at the University of Iowa, and a staff physician at University Hospitals. He sees patients at two adult reconstruction clinics, focusing on knees and hips, where he regularly deals with joint issues for boomers.

“I am seeing a number of patients in their 50s and even 40s,” he says. “Boomers are trying to stay more active and it wears on the body.” He adds that this increase in boomer joint treatments and surgeries is a change from the 1970s and 1980s, both because the techniques and philosophy have changed.

“Today we have better techniques ...,” Clark says. “And the philosophy has changed as well. Patients feel ‘I’ll have it replaced now and hopefully if it fails in 10 of 15 years, it can be revised at that time’ instead of waiting that 10 or 15 years to do the surgery.”

That was Gerard’s logic exactly. And he is well aware that his new hips will not last forever. “I am of the theory that I hurt now and am pretty active. So if I have to do this again when I am 75 or 80 years old, so be it,” he says “I’ll be pain free while I am younger and more active.”

Dr. Clark says joint replacement will benefit patients who are involved in the process and decision making. “They have to be motivated because this surgery is not going to fix everything,” he says. And while the surgery is going to greatly improve function and ease pain, he says boomers who elect to have joints replaced need to be more cautious with their active lifestyle.

“You shouldn’t do really strenuous things or take up something (you) didn’t do before after the surgery,” Clark says. “On the other hand, staying active, particularly doing things you have done in the past like running, swimming and non-aggressive skiing, is critical.”

Gerard is sticking to those doctor’s orders. While he says he is not going back to running, he continues to ride his bike, walk and do other non-impact sports, such as playing golf. “Now I don’t think I am missing out on something I want to do,” Gerard says.

And the pain relief he was afforded makes his decision to undergo hip replacement surgeries worth while. “I’m at the point now where I almost forget I had the surgeries,” he says. “It’s not like these things are clunky or you feel like you have a big metal thing inside you. What you end up with is, I think, better than original equipment.”

Of course there are other options beside a total replacement to treat baby boomer joint aches and pains, Dr. Clark says. In his practice, he does a lot of knee injections of steroids or synthetic disc fluid. There also is the possibility of a partial knee replacement. “This has the advantages of an easier operation and recovery,” he says. “It also leaves the option for total replacement down the road.”

He adds that a total joint replacement should be a last resort. “The decision to go with a total replacement depends on several factors including how it looks radioscopically, how severe the pain is, and how much function is limited,” Clark says. “We don’t want to do a replacement until one has severe arthritis or limitation of function has set in.”

Gerard said he hopes other boomers will realize they don’t need to suffer unnecessarily. “Your body will tell you when you should consider doing the surgery,” he says. “Don’t be afraid of the surgery. Do what gives you the quality of life you want to have.”