Saturday, January 13, 2024

The Operation Generation

Baby Boomers – men and women of a certain age – can also be thought of as members of an operation generation. Their grandparents were extremely unlikely to have undergone surgery for any condition. The odds their parents had surgery were much higher, but mostly for life saving and life prolonging procedures. For those earlier generations an osteoarthritic knee or a ligament tear were more likely to put a person on a cane for the rest of their life rather than the operating table.

Today, we the aging have higher expectations for surgery as a means of repairing damage and restoring mobility in order to sustain an active lifestyle later in life Be it hips, knees, ankles or feet, we are damaging ourselves more often than our parents did, and we want stuff fixed.

X-ray of knees showing thinning of cartilage 
between the bones (dark space) and mis-alignment
of bones in right knee (left side of image)
According to the American College of Rheumatology, each year there are close to 800,000 knee replacement surgeries in the United States. The number of hip replacements is a bit more than half that of knees, with the number of knee replacements per year is growing at a faster rate than hip replacements. The prime age for both procedures is 60-80 years, with the major cause being osteoarthritis.

Ligament and tendon surgeries are also trending up, and represent more evidence that we expect to stay physically active despite the betrayals of our bodies. Passage of Title IX in 1972 led to a ten-fold increase in the number of female students participating in competitive sports. One consequence has been an increase in knee surgeries to repair tears to the anterior cruciate ligament (ACL). Estimates are that there are more than 200,000 ACL surgeries per year, mostly associated with high school and college basketball, soccer and football teams. Not counting foorball, girls outnumber boys by about 3X.

Exact numbers are hard to come by, but Achilles tendon injuries are not so much the downfall of the active young athlete as they are of the somewhat older person, more likely male, who is living a sedentary life yet at times participates in recreational sports. The high risk age is 30-40, when the mind remembers how do to what the body has forgotten. This weekend warrior lifestyle leads to “Snap, Cripple and Pop!” Post-surgery recovery involves weeks in a cast, months in an adjustable boot, followed by more months of physical therapy exercises.

Knee replacement
The next generation will surely utilize surgery to improve on the human condition vis-à-vis performance. The concept was humorously presaged by Ray Bradbury’s 1954 story “The Watchful Poker Chip of H. Matisse.” His protagonist says “If somehow my leg was severed accidentally, I wouldn’t wear a wooden leg, no! I’d have a gold leg crusted with precious stones made, and part of the leg would be golden cage in which a bluebird would sing as I walked or sat talking to friends.”

More to the point, professional athletes are already having their vision laser-surgery modified to improve vision to 20/10. Gene modification theoretically could increase testosterone synthesis,  make muscles respond better to exercise, or permanently increase red blood cell production, thus carrying more oxygen. Only time will tell if our bones, cartilage and tendons (or our surgeons) can keep up with our muscles.

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