Joint Replacement

by Dillon Kato

Roy Strong is the CEO of Ortho Montana, an orthopedic surgery group in Billings that includes 17 physicians. He said the surgeons include specialists for hips and knees as well as shoulder and ankle replacement. That part of the business has continued to grow over the last several years, with more and more of the clients being aging baby boomers.

“These are people who are not sick people. They have good hearts and lungs, they are active Montanans and don’t want to be held down. They want to keep living that Montana lifestyle,” Strong said.

According to the American Academy of Orthopedic Surgeons, more than 645,000 total knee replacements were done in 2011, 45 percent of them to people younger than 65. In the same year, Americans underwent more than 306,000 total hip replacements, with nearly the same percent going to younger individuals.

As physician ability and the components that go into joint replacements have improved, the surgeries have become a far more common treatment, Strong said.

“You used to hear of times that physicians were saying wait until you’re in your 60s. That’s changing, and patients don’t want to live in misery for 10 or 15 years to wait for joint surgery to improve their lifestyle and pain,” he said.

Joint surgery earlier on can also lead to longer, healthier lives. When people’s joints function better and don’t hurt them, Strong said they are more likely to stay active, pick up a physical activity, or even just be able to go out for a walk with their children and grandchildren.

“If you can’t go out walking you’re more likely to be sitting around putting on weight. It’s important to
keep that under control to make joints last longer,” Strong said.

joint-replacementDr. Justin Jacobson, an orthopedic surgeon with Northern Rockies Orthopedics in Missoula, said part of the reason he attributes a rise in joint replacements to is a generational shift in how people think about
pain, as well as a society that is wanting to stay active longer in life.

“The younger generation doesn’t want to live with pain so much anymore,” he said. “I get a lot of people
that say they are not happy with just existing. It’s not just surviving, it’s living.”

Insurance, driven by Medicare, is increasingly requiring that patients go through all other avenues of treatment before covering surgery. Jacobson said the trend of insurance becoming more restrictive will
only continue.

Because replacement joints will also wear out eventually, Jacobson said he generally tries to convince patients not to undergo surgery until their pain is limiting their lifestyle. He said there are a variety of
preventative steps that can be taken early on to prolong or even negate the need for joint replacements.

“One of the biggest is weight control, there’s no doubt that it affects your joint surfaces,” Jacobson said.

Heavier people also have a lower rate of success in joint replacements, and the risk of complications from surgery goes up. Smoking is another risk factor. Not only does it affect bone density, Jacobson said, it also reduces the body’s ability to heal tissue damage, both from wear from daily life as well as when recovering from an operation.

Another part of the job Jacobson said he spends a lot of time on is counseling his patients to make sure that what they expect from a joint replacement is realistic.

“I think there’s a misconception generally that if you replace a knee you can do everything you could before,” he said.

After surgery, there are certain activities Jacobson councils his patients not to do. He said he suggests
runners transition to biking, and that skiers stay on groomed trails and off of moguls. Those conversations are most difficult with younger patients who might otherwise be healthy, but should still consider bringing down the intensity of their physical activity as they age.

“I explain to them that it’s like a brake pad. It only has so many miles you can put on it,” Jacobson said.

Dillon Kato is a reporter for the Missoulian. He can be reached at