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In Motion August 2013

Baby Boomers Seek Orthopaedic ‘Repairs’ to Stay Active

By Timothy Gajewski, MD

The baby boomer generation is aging (born from 1946-1964). In 2011, the first boomers turned 65. By 2030, Americans 65 and older will make up 20 percent of the population. With a "graying" population comes an increasing number of medical and musculoskeletal problems. One of these is arthritis, which is the leading cause of disability in this country. Half of all 60 year olds will have symptoms of arthritis.

Baby boomers are now dealing with these joint issues. They are an active generation with no desire to sit still. Orthopaedic surgeons are working hard to allow them to maintain their active lifestyles.

When patients with arthritic hips and knees no longer respond to conservative care such as medications and physical therapy, orthopaedic surgeons are able to replace these joints. Hip and knee replacements are among the most successful and satisfying surgical procedures. Nearly one million hip and knee replacements will be performed in the U.S. this year.

The first total joint replacements were done in the 1960s. Since then, there have been many advances in joint replacement. These innovations have made the procedures safer and the rehabilitation time quicker.

The goal of joint replacement is to relieve pain and restore function. This needs to be done as safely and accurately as possible with a minimum of complications. Today’s artificial joints are allowing patients to return to high levels of activity.

Baby boomers have high expectations when they have surgery. They expect to be back to full strength—or near full strength—in a short time, and orthopaedic surgeons are meeting these expectations with "accelerated rehab," improved post-operative pain control, computer "navigation" during surgery, and patient-specific instrumentation.

Through the decades there have been steady improvements in the quality of joints. Advances in prosthetic design and biomaterials are improving motion as well as the length of the life of these joints. This means they are lighter and stronger and last longer than ever before.

It's an exciting time to be a baby boomer. Arthritic joints no longer mean you have to stop being active. Today’s artificial joints are meeting and exceeding their expectations for a full return to regular activities.

This is good news for an active generation that has no intention of slowing down.

Timothy Gajewski, MD, is an orthopaedic surgeon who specializes in hip and knee replacement. For an appointment with Dr. Gajewski or another orthopaedic surgeon, please call 440.312.6242.

Innovative Hip Surgery Has Advantages for the Right Patients

By Robert Hampton, DO

Arthritis of the hips is one of the main conditions that slows people down as they age. For many, orthopaedic surgery is a good treatment option. In fact, nearly one million people in the U.S. undergo total hip replacement each year.

Today, about 80 percent of hip replacement surgeries in this country are performed through a posterior approach in which the incision and surgery are performed toward the buttocks (posteriorly). The anterior approach is done by an incision from the front of the body. This means that the surgeon performs the hip replacement between the muscles rather than removing and reattaching the muscles.

The anterior approach is not for every patient but it does have its advantages for some people. If you are going to have hip replacement surgery, it’s important to work with your orthopaedic surgeon to determine what is right for you.

Age, activity level, bone quality and anatomic structure all play a role in determining if a patient is a good candidate for the anterior approach. For younger candidates and people who are highly active, the anterior approach may be preferred.

This surgical approach may minimize post-operative pain, leg length discrepancies, dislocations, painful limp and sciatic nerve injury. But again, bone quality and the anatomic structure are critical to the decision process.

The anterior approach has been widely used in Europe for about 20 years, and just in the last decade has become more widespread in the U.S. The surgeon must have special training on the procedure and may require the use of a special surgical table.

Cleveland Clinic offers the anterior approach to hip replacement at a number of its locations.

The main thing to keep in mind is that when necessary, having hip surgery can improve your quality of life no matter which approach is used. The most important thing is for you to decide on having the surgery. You can then work with your surgeon to determine the best option for you.

Robert Hampton, DO, is an orthopaedic surgeon who specializes in hip and knee replacements. To schedule an appointment with Dr. Hampton or another orthopaedic surgeon, call 440.312.6242.

Bicycling for Wellness

By Michael Schaefer, MD

As the weather gets warmer, many of us turn to an old love for exercise – the bicycle! When we were children, we rode our bikes all over the neighborhood and now we remember the feeling of speed and freedom it gave us. Now, as adults, bicycling offers an excellent form of exercise, especially for those of us who suffer with long-term joint problems.

First, it is a “non-impact,” activity, meaning it puts less stress through the hips, knees and feet. It also can be done at a wide range of intensities – that is, if your tendency is to go a little slower, you can coast once in a while, or use lower gears to ease the burden on your legs. Finally, by bicycling we generate our own breeze, so we can often venture outdoors on warmer days when it is too hot to walk or jog.

The benefits of bicycling are greatest for the leg muscles. Pedaling works most of the major muscle groups – the quadriceps, glutes and hamstrings. It also gives some exercise to the calf muscles and the ankle groups.

Most importantly, it uses the heart and lungs. Increasing the pedaling speed, or adding hills can give an excellent cardiovascular workout. To some extent, the spine, arms, shoulders and core muscles also get strengthened. For some patients who have spinal stenosis, the bent-forward posture of bicycling actually relieves pain. Those with neck or arm problems, however, should consider using a recumbent (sit-down style) bicycle.

Before you venture out on your bicycle, there are a few important considerations:

  1. First, check with your primary care provider or musculoskeletal specialist to make sure that bicycling is appropriate for you. If you have known heart trouble or neurological issues, you should seek the opinion of specialists in these areas.
  2. Safety-wise, you should always wear a bicycle helmet. Modern helmets are very lightweight and have excellent ventilation. A helmet must fit properly to protect you, so it should be purchased and sized at a local bicycle shop.
    In addition to a helmet, you should wear eye protection--simple sunglasses are probably good enough. Always wear brightly colored, visible clothing and ride during daylight hours only. And consider using bicycling gloves to protect your hands from vibration, or from injury in the event of a fall. For longer rides, don’t forget the sunscreen.
  3. Bicycle fit is also important. Even if you are using an older bicycle that you’ve owned for years, you should visit a local bike shop to have it properly “fit” for you. Most reputable shops have salespeople who are trained in bicycle fitting. Many have knowledge of common orthopaedic conditions, and they are often able to make adjustments to help you accommodate to them. For instance, patients with knee pain usually feel more comfortable with their seats in an elevated position. Neck pain can often be relieved by using raised handlebars. And a good pair of padded bicycling shorts goes a long way to preventing skin sores.
  4. Finally, where to ride? When selecting your route, safety should be the most important consideration. Many towns have dedicated bike trails to keep you separated from traffic. Many local governments also have published maps that show recommended bike routes.

Bicycling may take some getting used to, so don’t get disheartened if your first ride is more challenging than you expected it to be. Start with a short ride, perhaps just five or ten minutes. Give your body some time to adjust to the new position and exercise. Before long, you’ll be peddling easily and whizzing along like a kid again!

Michael Schaefer, MD, is director of Musculoskeletal Rehabilitation at Cleveland Clinic. To make an appointment with Dr. Schaefer or another musculoskeletal specialist, call 216.312.6242.

All about Arthritis: What You Want to Know

By Apostolos Kontzias, MD

These are some of the common questions I hear from patients about arthritis.

Q. Is there an age when people typically begin to suffer from arthritis?

People of all ages can suffer from arthritis, but certain types of arthritis affect specific age groups. For example, osteoarthritis (considered the “wear and tear” arthritis) is one of the most common types, and it most often affects people in their 50s and older. But keep in mind that given the “appropriate” genetic background, osteoarthritis can start earlier—especially in your hands. Rheumatoid arthritis, an autoimmune disease that causes chronic inflammation, most often affects women between the ages of 30 and 60 years old.

Q. Is it hereditary or do most people have it?

Arthritis has many causes. Recent research has identified genes that predispose people to specific types of arthritis, but other factors also come into play. Environmental triggers like stress and the functional status of your immune system have an impact. Some people’s immune systems are over-reactive to external stimuli, which can lead to arthritis. For other kinds of arthritis, genetics impacts how fast your cartilage loses its water content and its capacity to repair itself, which leads to osteoarthritis.

Q. If you’re athletic, are you more prone to suffer from arthritis?

Until more recently, we believed that engaging in athletic activities was detrimental for your joints. In reality, this depends on the kind of sports you do and your baseline fitness status. Overall low to moderate aerobic exercise is great for both your joints and your immune system. Physical therapy in the form of water aerobics and many land-based exercises are prescribed by healthcare providers and are considered the backbone of all arthritis treatment strategies.

Q. Are certain activities or sports worse for arthritis?

High impact exercise and sports have the potential to cause injuries that can lead to the development of arthritis—mainly osteoarthritis. If you have pre-existing arthritis or are genetically prone to arthritis, you should engage in mild to moderate activities such as swimming, cycling and walking. Certain injuries that cause direct damage to the cartilage, such as ligament injuries, fractures and dislocations, can compromise the joints. Equally important to avoiding injuries is appropriate stretching and preconditioning prior to any activity.

Q. What are some general guidelines for caring for my arthritis?

These pointers will help to improve your symptoms and ultimately your quality of life.


Be active every day, and exercise at least 30 minutes as many days of the week as you can. The best types of exercises include range of motion, strengthening and aerobic exercises such as walking, water exercise and bicycling.

  • Keep your weight down by eating a balanced diet that includes vegetables, fruits and whole grains. Eat less sugar, salt, fat and cholesterol.
  • Keep in mind that for every pound of weight lost, four pounds of pressure is taken off of each knee.
  • Be aware of new “cure-all” diets as they are not always proven to help and can sometimes pose health risks.
  • Make an appointment with a dietitian if you need assistance in eating a healthy diet.
  • Work with your doctor to find safe strategies for the type of arthritis you have.
  • Do not take too many over-the-counter painkillers, which can have side effects, especially in the presence of other health problems.
  • If you are experiencing arthritis symptoms, do not wait to seek treatment. Early diagnosis leads to faster and better results.

Apostolos Kontzias, MD, is a rheumatologist in the Arthritis & Musculoskeletal Center; he specializes in osteoarthritis and rheumatoid arthritis. To make an appointment with Dr. Kontzias or any of our rheumatologists, please call 440.312.6242.

Staying Healthy as a Senior Athlete

By AJ Cianflocco, MD

This summer, more than 11,000 senior athletes came from all over the country to compete in the National Senior Games held in Cleveland, Ohio. These athletes participated in 19 events—from archery and shuffleboard to tennis and volleyball.

The good news is that staying physically active as you age can help prevent and even reverse some physiological changes. The key is avoiding total inactivity for any length of time as this can lead to loss of flexibility, strength and bone mass as well as reduced heart function. Also important is allowing time for rest and recovery and modifying your activity. As you age, it is a matter of understanding your body’s cues and following some preventive measures.

Getting Started with Exercise

Regular activity helps maintain good health and physical independence as we age. The following are recommended:

  • Low-impact aerobic or endurance exercises such as walking, swimming and dancing
  • Strengthening exercises such as weight machines or elastic bands. Be sure to get medical clearance and consider a personal trainer for proper technique.
  • Tai chi or senior yoga for balance, strength and flexibility

For seniors, the basics of injury prevention include:

  • A good warm-up before, and cool-down after, every activity
  • Being consistent in the frequency, duration and intensity of your activity
  • Alternating days of more intense activity with less strenuous days
  • Attention to environmental conditions such as temperature and humidity
  • Maintaining proper nutrition and hydration to promote good health and optimal athletic performance
What to Watch For

Aging affects multiple organ systems, from the heart and lungs to your bones and metabolism. Of all the changes, musculoskeletal issues have the most impact on the aging senior’s sport. These changes include an overall decrease in muscle and bone mass, stiffening of muscles and weakening of tendons and cartilage.

To avoid chronic problems and longer rehabilitation times when an injury does occur, seek treatment immediately. Initial care consists of protection, rest, ice, compression and elevation. This should be followed up by a guided and progressive rehabilitation program. Physical therapy should focus on restoring function and include range of motion, flexibility and strengthening exercises.

Other issues to consider

Older athletes also need to pay closer attention to temperature-related illness. Heat illness can occur because there is an increased risk of dehydration, decreased sweat gland function, and impaired blood flow in response to elevated core temperatures. Medications, such as beta-blockers and diuretics, increase risk of heat illness.

By applying many of the same guidelines used by younger athletes for training, injury management and injury prevention—and being more aware of the physical changes that occur as part of the maturation process—the senior athlete can stay active for a lifetime. And staying active can help manage or prevent many medical conditions, including heart disease, high blood pressure, diabetes, cancer and osteoporosis.

Be sure to consult a medical professional if you are planning to start an exercise routine or if you are a senior athlete experiencing any physical changes.

AJ Cianflocco, MD, is a sports medicine physician who specializes in orthopaedic care, sports medicine, neck and back problems. For an appointment with Dr. Cianflocco or any of our primary care sports medicine doctors, call 440.312.6242.

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