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Why are knee replacements and other orthopaedic surgeries on the rise?


Why are knee replacements and other orthopaedic surgeries on the rise? We talk to two of the doctors who are participating in The Academy of Orthopaedic Surgeons meeting taking place in San Diego this week.

The Academy of Orthopaedic Surgeons and the California Orthopaedic Society will host a free public forum on Saturday, February 19, 2011 from 9:30 a.m. to noon.

Why are knee replacements and other orthopaedic surgeries on the rise? We talk to two of the doctors who are participating in The Academy of Orthopaedic Surgeons meeting taking place in San Diego this week.


Dr. James P. Tasto, clinical professor of orthopaedic surgery at the University of California, San Diego and in private practice at the San Diego Sports Medicine & Orthopaedic Center.

Dr. Elena Losina, Co-Director of OrACORe at Brigham and Women's Hospital and Associate Professor of Orthopedics at Harvard Medical School, as well as Associate Professor of Biostatistics, Boston University School of Public Health.

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CAVANAUGH: I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. You just happened to mention to a stranger downtown this week that your back is killing you, you may quiet more of an answer than you expect. Thousands of orthopedic surgeons are in San Diego to attend a national conference at the convention center. Among the hot topics on the agenda is the boom in knee replacement surgeries, and how pip replacements may now be available for people who are up to their '80s. I'd like to introduce my guests, doctor James Tasto is a clinical professor of orthopedic surgery at UC San Diego, and in private practice at the [CHECK] and doctor Tasto, welcome.

TASTO: Thank you.

MAUREEN CAVANAUGH: Doctor Elena Losina is associate professor of orthopedics at Harvard medical school as well as [CHECK] welcome.

LOSINA: Thank you.

MAUREEN CAVANAUGH: And let me start with you, doctor Tasto, just so we all upon what we're talking about, what qualifies as orthopedic surgery? What are the range of things that orthopedic surgeons do?

TASTO: Well, in general, we kind of deal with disorders, whether they're surgical or nonsurgical, in joints issue muscles, bones issue ligaments, and it really sears from the pediatric population all the way up to the geriatric population.

MAUREEN CAVANAUGH: Well, now, I introduced you, you're [CHECK] so I guess sports injuries are a large part of your practice?

TASTO: Yes, I specialize in sports medicine which really runs the entire gamut of ages as well, not just athletes in their prime, but also older citizens and rotator cuff injuries in a 70-year-old golfer.


TASTO: It's a very, very broad field.

MAUREEN CAVANAUGH: What are some of the other causes of orthopedic injuries besides sports?

TASTO: Trauma, of course, is probably the most prolific of them all in terms of auto accidents, and people thought falling, breaking their hips and breaking their ankles. So I'd have to say trauma is probably the overriding most common thing we see in everyday practice.

MAUREEN CAVANAUGH: Doctor Elena Losina, you're [CHECK] Bringam and Women's Hospital at Harvard. What are the goals of that center?

LOSINA: What our goals are to study outcomes of orthopedic procedures, and focus on outcomes of hip replacement, and knee replacement. Frequently used procedures to improve quality of life in [CHECK].

MAUREEN CAVANAUGH: Now, doctor Losina, I know that one of the topics that's gonna be covered at the convention downtown is this, really, boom in knee replacement surgeries that don't want correspond to an increase in population, they don't even respond to an increase in obesity. So what's your take on why the number of these procedures has increased so significantly over the past ten years?

LOSINA: I think over the past ten plus years, there is a vast body of evidence Ememoringly in medical literature that total knee replacement is a very safe and successful surgery. Over 90 percent of people undergoing the surgery re, [CHECK] people are more comfortable with undergoing the surgery, and surgeons are more comfortable to offering the surgery, so that may contribute to the fact that more and more knee replacements are deputy in the United States.

MAUREEN CAVANAUGH: And what age range, Doctor Losina, what age range are your parent, generally, for knee replacements?

LOSINA: It varies greatly. It comes as early as in '40s and it goes as late for people in 90s.


LOSINA: Yes. Of if people are suffering and their knees hurt, I think this procedure can relieve pain and make them feel better. So I don't think aiming is related to how well the surgery will go. I think it's successful, and there are many ages. [CHECK] whether patients are comfortable to take it.

MAUREEN CAVANAUGH: Doctor Tasto, we hear a lot in sports medicine that some people do, of course, get total knee replacements but they have a knee surgery a great deal. And what is the difference between that kind of total knee replacement and the kind of detailed knee surgery that orthopedic surgeons do for athletes.

TASTO: Well, starting really in the teens our younger population participates in an awful lot of activities that have a tendency to sustain injuries to the knee. Let's take for example family soccer players, and in their teens issue the propensity of ACL injury, which is the anterior [CHECK] so it's an epidemic. And they tear their ACL, we then reconstruct their knee, and we allow them to go back into sports because they now have a stable knee. The problem with that is that they are now going back on a knee that is maybe a 95 percent knee, it's been artificially reconstructed and they have a tendency sometimes to tear their knee again. So some of these people that have had multiple repeated orthoscopic procedures, ligament reconstruction or cartilage repair will have these [CHECK] ACL has had two operators on her knee, her teens, will start to have some arthritic changes in their thirties.


TASTO: So this is when we're looking at other procedures to try TO salvage that knee, and some of these people after multiple injuries when they're young will come to a total knee replacement at a younger age.

MAUREEN CAVANAUGH: And doctor Tasto, as I was speaking with

Dr. Losina, I think we're surprised to hear that you can do knee replacement or apparently even a hip replacement for very eastern adults, people who are in their 80s and so forth. Is that an advancement, especially when it comes to hip replacements and being able to successfully perform that kind of orthopedic surgery on a patient that old.

TASTO: Yes. I was exposed to knee and hip replacements pretty close to 35 or 40 years ago when they first started, and we really had a age cut off at that stage. Because we really didn't have the techniques down. The cementing techniques issue the changing in pros these I guess, the [CHECK] much longer life expectancies for these -- for the replacements themselves. So now we're able to do them at a younger age and still have faith that this is going to last a longer period of time. And with people having all the sophisticated reconstructive surgery when they're young, these people now instead of being sedentary are back in an activity level that's going to accelerate their aging.

MAUREEN CAVANAUGH: Right. Doctor Losina, what do you get out of a national conference like the one taking place here in San Diego? What are orthopedic surgeons gonna be able to learn from each other?

LOSINA: I know an out [[]] newest advancements in techniques will be presented and long-term experiences and risks of revisions and what makes the procedure more successful, and how to achieve higher longevity of pros thesis, we in our research center are very interested in long-term outcomes and cost effectiveness of orthopedic procedures and I'm looking forward to getting new data, and we can build some computer simulation model in trying to look at the long-term impact of orthopedic advancements.

MAUREEN CAVANAUGH: Because, one of the things that people complain about, Doctor Tasto, is the persistence oaf certain problems when they have back problems and they try to correct them with surgery, and they're not corrected in that way. And what kind of advances have been made to help people who do have these chronic problems with pain that's surgeries don't team to be able to correct?

TASTO: Well, I think the world of orthopedics, encompasses both the conservative care and the surgical care, so we have to recognize that 134 inter~ pas, they have a painful condition in their back or their knees or their hips and it's not ark meanable to the surgical procedure.


TASTO: Which we have, over the course of the past 15 or 20 years developed [CHECK] local injections of court zone, local injections of hideronic acid in the knee, it's hear, and these are ways to promote a better lifestyle without a surgical intervention, so that there is a significant role for conservative care of many conditions that we come across every day particularly in the spine. The spin has are have very difficult to correct back pain. And so sometimes surgery isn't as effective, and we have to use other modalities.

MAUREEN CAVANAUGH: As people live longer and longer, doctor Tasto, I'm wondering if you're seeing the replacements of joints, especially joints like the hip and the knee, to become more and more routine.

TASTO: Absolutely. Unfortunately, what we don't want is to have the public's expectations --

CAVANAUGH: That they can just go in and get a new hip, right?

TASTO: Right. Come in and give me a new knee because I have eye golf game on Saturday. And that's just not the way it is. So we have to make sure that -- well informed on the track that you're going to pursue. And most recently shoulder replacements and a non-weight bearing joint have become more significant than they were [CHECK] rotator cuff is completely torn and the shoulder is arthritic, we is now replace this with a particular prosthesis that will give these people function. [CHECK].

MAUREEN CAVANAUGH: What kind of tips might you be able to share with our audience for people preventing the kind of orthopedic injuries that you have to do surgeries on people for? What should we all do?

LOSINA: I think it's really important to -- we all are striving to increase our physical activity levels, but it's really important to do proper stretching and for kids who play high level sports, it's important to use appropriate prevention against ACL injuries, and against injuries while running, so I think that's outstanding biggest challenge, and I think we issue equipped with knowledge and we have to do it. But I think we just need to raise awareness that sports injuries not only link to short term detrimented quality of life, and the need for treatment, but also may affect long-term equipment for arthritis, which may be a lifelong problem.

MAUREEN CAVANAUGH: And doctor Tasto, we hear so much about obesity being a problem in the United States, is that also -- does that also increase the likely hood that your joints are just are gonna wear out.

TASTO: Yeah QI think there's obviously a very significant correlation between obesity and even patients that are just slightly over weight, in terms of the stress that's put on their hips and knees and their weight bearing joints. And will if we can get people to control their weight, control their diet, you get them some type of exercise regime, whether it's a stationary bike or an, elliptical. Of [CHECK] but it should be stretching and it should be muscle strengthening and training. So that can really add to the longevity of our joints of and it's critical. I see so many people, up have the young athlete who's obviously in good shape, and then you have the rest of us, and we need a lecture. And that's the lecture I just gave you.

MAUREEN CAVANAUGH: I appreciate it. Well, I want to thank you both. Doctor James Tasto.

TASTO: Thank you very much. Hey, it's a pleasure to be here. Thank you.

MAUREEN CAVANAUGH: And Doctor Elena Losina.

LOSINA: Thank you for having me.

MAUREEN CAVANAUGH: Will be meeting at the San Diego convention center until Saturday, February 19th, and if you would like to comment, please go on-line, Days. Stay with us for hour two of These Days coming up in just a few empties right here on KPBS.


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