Orthopedic breakthroughs

In the waiting rooms of southwest Florida's orthopedic specialists, "weekend warriors" and active seniors are replacing the decades-old stereotype of seniors with broken hips.

Our climate naturally attracts a more active older set of residents, who are staying in shape golfing, walking, swimming and playing tennis. Meanwhile, baby boomers trying to defy birthdays starting with the numbers 4, 5 and 6 embrace the weekend warrior lifestyle, occasionally playing hard, but often without maintaining the fitness level to support sporadic, enthusiastic recreation.

"I think baby boomers with sports injuries would probably be divided into two problem areas;" says Dr. Fletcher Reynolds, of Orthopedic Specialists of SW Florida, "those with acute problems, which happened as a result of a sport. . . more of your knee injuries, shoulder and rotator cuff tears, and meniscus tears. And the other group, which has arthritis," he explains, "and they exacerbate it by doing sports activities. They have an ongoing problem."

Orthopedic Specialist Dr. John Kagan also sees a lot of boomers with recreational

REYNOLDS injuries - mostly shoulder and knee, but he mentions the elbow as another trouble zone. Some of his patients get a surprise when they hear why they've hurt themselves. "You may have a small tear in your knee that you twisted getting out of a car 10 years ago," explains Kagan, "but then you go for a shot, and you feel something tear." And over time, he says, an area like the rotator cuff can tear as a result of lots of small micro-tears. Why injuries occur

"As we get older," says Kagan, "we start to lose some elasticity in our tendons, and our ligaments may become a little stretched. As time goes on, they're not quite as strong, and our connective tissue (ligaments, tendons) lose their elasticity. The bones also become more brittle." So basically, as a person ages, he or she becomes more prone to getting hurt, "a little bit more at risk to have an injury," he says.

"An activity that you might have done when you were 15," says Kagan, "one that you didn't warm up for properly, and didn't follow the normal guidelines on how to do things - you got away with it. Your body could absorb the extra stresses that you put on it. But," he warns, "that won't work at 55 and 65."

KAGAN The shoulder and rotator cuff are a classic example. "There are basic activities that are repetitive," explains Kagan, "which can cause micro-trauma to the rotator cuff. We can deal with that when we're younger," he says, "but then the circulatory things change a little bit, and elasticity and tendons change a little bit, and we develop some (bone) spurs above the shoulder."

Those spurs can cause real pain.

Bionic breakthroughs

"We do see a lot of patients from this age range with advanced arthritic changes in the hips and knees," says Dr. David Heligman of Institute for Orthopaedic Surgery & Sports Medicine. "Twenty years ago, our abilities with replacement were pretty archaic," he says of orthopedic surgeons. "Now with our state-of-the-art joint replacement techniques and improved metals," he explains, "many of these patients are undergoing hip and knee replacements as early as in their 40s, with expectations that the replacement will last twenty, thirty, even forty years, allowing these young-at-heart patients to maintain a very active lifestyle."

HELIGMAN Dr. Reynolds further explains some exciting new developments. "There are new designs of knee and hip replacements;" he says, "different surfaces that make up the replacement, such as ceramic and metal, instead of plastic. They'll last longer."

There are also new types of knee replacements he explains. "There are new "mobile-bearing" and "high-flexion" knee replacements, that allow for greater range of motion for the joint, and hopefully, also will last longer. We're not sure yet," he says of these procedures which have yet to stand the test of time, "but at least in the lab studies that have been done on them, that's what it would appear."

You might not need surgery

There are obvious signs that it's time to talk about a pain with an orthopedic specialist. "Persistent pain in the hip or knee for a few weeks," lists Heligman. "Pain that doesn't respond to over-thecounter medicine like Advil or Aleve." Heligman says people who relate to this description should consult their orthopedic surgeon so that they can be advised.

Medical technology and procedures are advancing so fast that it's difficult for consumers to keep up. This is part three of Florida Weekly's eight-part series examining what's new in medicine in Southwest Florida. NEXT WEEK: Dermatology. Kagan addresses the same scenario, echoing Heligman. "You start having symptoms," he says, of a person with pain, "and you do the normal things, which are rest, ice, elevation. You take some basic anti-inflammatory (Motrin, Aleve, ibuprofen). But let's assume that you do all this and you don't get better. Then you need to see the doctor."

Many people live with pain rather than visit an orthopedist simply because they assume the doctor will recommend surgery. In fact, there are alternatives which can and do correct painful problems for many. "Their problems may be manageable with anti-inflammatory medicine," says Heligman of certain patients. Cortisone injections are also successfully used to repair pain in particular areas, but can have side effects. An orthopedic specialist can go over all the options and recommend which one is most likely to work for a given situation.

Some patients who fear being told they need surgery find they only need to get rid of a bone spur to alleviate their pain. A bone spur (osteophyte) is just extra bone growth, on top of bone. Sometimes spurs form as part of the aging process; other times, in response to stress, rubbing, or pressure over time. If a spur presses on soft tissue or other bones, it can cause pain or wear and tear. Having a spur removed is a fix for many lucky patients.

Address pain early

"The key issue is that if you have a rotator cuff tear," says Kagan, "fix it when it's little. The larger the tear, the less well it heals; circulation's not as good." Small tears can be treated with a better outcome, he says; procrastination can actually be dangerous. "You're better off getting it fixed, and letting it heal, rather than waiting until the point when you can't use your arm."

Even if is surgery is required, arthroscopic techniques lessen the risks. "Almost all of the rotator cuff tears are fixed arthroscopically," says Reynolds, who does 98 percent of his rotator cuff surgeries this way. He also repairs knees and cartilage tears this way.

Reynolds describes how arthroscopic surgery is done, using a camera and tiny puncture holes, as opposed to completely opening the shoulder or other injured area. "The pain is a lot less," he says, "and the recovery is a lot quicker." There's also a lower risk of infection," he says, of arthroscopy, which is often done on an out-patient basis at a surgery center.

"Minimally invasive hip and knee surgery has allowed us to make much smaller incisions," says Dr. Heligman. Incisions are now typically only 4-6 inches for a hip or knee, with less tissue trauma, less pain and a quicker recovery. "With our newer technologies," he says, "we're able to get these weekend warriors back to a very active lifestyle: aggressive tennis, golf, and overall, an improved quality of life." Preventive measures

Dr. Kagan gives advice to active types hoping to avoid a visit to the orthopedist. "You have to understand that the main protective force that we have for our joints," he says, "are our muscles and ligaments. "It's very important you to maintain good muscle fitness. And it's very important to warm up," before any physical activity, he explains, warning that if you don't, "You're going to hurt yourself.

"There's got to be blood supply going to the area," he says, "before you go out and provide a maximal effort." Kagan advises active types to put an emphasis on being "properly rested, getting proper nutrition, and then being properly fit to do the activity you want to do." These kinds of things give you a level of protection," he says, "and then you've done all you can do."