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A Knee-Jerk Reaction to Avoid

Experts say active baby boomers should skip knee surgery and try taking it easy

WEDNESDAY, Feb. 13, 2002 (HealthDayNews) -- Aging weekend warriors, listen up!

Whether you're a jogger, a tennis player or a baby boomer who enjoys all sports, if your knees are starting to give out, skip the thought of surgery and just give them a rest.

That's the advice of the Mayo Clinic's Dr. Arlen D. Hanssen, who offered those words of caution in a report today at the annual meeting of The American Academy of Orthopaedic Surgeons in Dallas.

"Unless the pain is such that it interferes with activities associated with normal living, baby boomers should not be encouraged to have knee surgery, but instead be advised to modify their athletic activities to reduce stress on their knees," Hanssen says.

Indeed, Hanssen is one of a growing number of orthopedic surgeons who suggest boomers treat their knee pain more conservatively -- starting with swapping fitness activities like jogging and basketball for more knee-friendly exercise such as swimming, riding a stationary bike or even walking.

"If need be, medication and physical therapy can also be added to help manage the pain," says Hanssen, a professor of orthopedics at the Mayo Medical School.

What's not appropriate, he says, is automatically turning to surgery -- either ligament repair or even total knee replacement -- before you try the conservative approach.

New York City orthopedic surgeon Dr. William McCauley calls the advice sound.

"Only after all other treatment possibilities have failed to bring relief -- and that includes stopping the offending fitness activity -- then, and only then, do we recommend surgery be considered," says McCauley, director of the Center for Hip and Knee Replacement at Columbia Presbyterian Medical Center.

The idea to cut back on boomer operations grew out of the recognition that a patient's age has a lot to do with how well -- and how long -- the "new" knee will last, Hanssen says.

"While older folks have usually stopped their high level of activity by the time they are getting a knee replacement, not so for younger people," he says.

Boomers are far more likely to want the knee surgery so they can continue leading their active lifestyle, including participating in the sport that harmed their knees to begin with, Hanssen says.

Inevitably, the new knee wears out and the pain returns, he says.

The other common surgical option -- a ligament repair, often done for injuries such as a painful tear near or around the knee -- works well for people in their 20s or 30s. However, it's not a good idea for middle-aged fitness buffs, Hanssen cautions.

"Most of the time, younger adults have not yet seen arthritis develop in their knee, so the ligament surgery will help them, and, most importantly, is likely to relieve their pain," he says.

By comparison, a boomer with a similar problem is likely to have some arthritis in the knee as well. So, surgically repairing the ligament won't do the trick, Hanssen says.

"They'll still have the arthritis to contend with, so the operation is not going to give them that pain relief they are seeking," Hanssen says.

Instead, he encourages a gentler course of treatment involving rest, physical therapy and, if necessary, medications to ease inflammation and pain.

Ironically, surgery often leaves boomers exactly where they would be if they had taken the more conservative approach, McCauley says.

"They find they still have to cut down or change their fitness activities. In addition, they can find themselves in need of medication or therapy as well. So, why go through the surgery? Why not just make these changes in the first place and see if they help," McCauley says.

Since doctors are the ones who perform these operations, it's clear they play a major role in any inappropriate surgeries. However, Hanssen says boomer athletes are at least partially to blame.

"Many of them hear or read about these surgeries. They read about pro sports figures who have them and go back to the game, and they think they can do the same thing. So they push hard for the surgery, and sometimes doctors have no choice but to give in," Hanssen says.

The best advice, for both doctors and boomer patients, is to be selective about treatments and always make surgery the last resort, Hanssen and McCauley say.

What To Do: For more information on knee injuries and potential treatments, visit The Center for Hip and Knee Replacement. You can also look at this list of resources on knee surgery.

SOURCES: Interviews with Arlen D. Hanssen, M.D., professor, orthopedics, Mayo Medical School, Rochester, Minn.; William McCauley, assistant professor, orthopaedic surgery, and director, Center for Hip and Knee Replacement, Columbia Presbyterian Medical Center, New York City; Feb. 13, 2002, presentation, annual meeting, The American Academy of Orthopaedic Surgeons, Dallas
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