Wear, Tear and Repair: Options for maintaining mobility

1
Wear, Tear and RepairOptions for maintaining
mobility

• Vonda Wright, M.D.
• University of Pittsburgh
• Center for Sports Medicine

2
Active agers and adult onset exercisers
3
Picture This!
Banana George Blair- 92yo
4
Not the exception!
(Novakofski Photography)
Cliff Tatana Eggink- 68
Gene Wright- 65
Banana George- 80

Active aging is within our grasp.the key is
exercise!
5
An ancient preoccupation-

• Socrates- The Republic
• abhorred aging.represented corruption of the
  Greek and Roman ideal of
• Youthful Vigour
• would you have me slow down as I near the finish
  line?

6
it is our duty to resist old age to compensate
for its defects, to fight against it as we would
fight a disease to adopt a regimen of health
to practice moderate exercise and to take just
enough food and drink to restore our strength.
Cicero 44BC
7
Active Booming Seniors

• Good news
• 25 of 41.3 million gym members are gt55
• Exercise participation growing at 3x the rate of
  those from 34-54.
• 11/5/06-NYC marathon-
• nearly 20 gt50yo
• National Senior Games-
• 11,000 in 2005

8
AARP percent physically active
28.8
25.6
16.3
9
Percent growth in frequent participation in
health clubs from 1998-2004
33
13
0
10
Knowledge is not Action!2005 National Public
Health Week Survey gt55yo
18
40
78
11
Top 4 reasons for inactivity

• Fear of falling
• Unwillingness to take action
• Resistance to exercise
• Fear of injury

12
Barriers to activity

• Access
• if half of older Americans decided to join
  clubsthere would not be enough locations to
  accommodate them.
• Guidance
• HC provider are powerful influences! powerful-
• only 52 of patients asked about physical fitness
  in last year (UCSF)
• Lack of knowledge of evidence-based exercise
  prescription
• Training emphasizes medication not physical
  activity
• Few tools for exercise prescription
• Physical activity counseling not reimbursed by
  insurance.

13
Why is all of this important?

• Direct costs of physical activity-
• 76.6 billion in 2000 with
• care of people with chronic illness more than 1.4
  trillion (CDC)
• forecasted to grow to 2.8 trillion (9,216 per
  person) by 2011
• Engaging in physical activity-
• less medication
• fewer hospitalizations
• Fewer physician visits
• Health partners adults over 50yo start
  exercising only 90 minutes a week save an average
  of 2,200 per year in medical costs.

14
75 yo is the tipping point If functional decline
occurs at 75 in the best of the best.it may
happen earlier in sedentary people
Disability
Independence
Cost to HC Cost to Society
Baby boomers are 59..we have 16 years to
intervene before the elder surge reaches 75.
15
How do we get the word out?Change the face of
aging!

• AAOS/NATA media events-
• News to the News-makers
• Internet- boomers not seniors
• 33.2 million 50-64yo on line)
• 73.7 by 2008 (emarketer05)
• 3 times the number over 65
• Physician training

16
Wear, Tear, Repair

• Our unique body
• Osteoarthritis
• Total joint
• replacement
• Options for maintaining mobility

17
Your Unique Body!You are not merely a sequel to
your 20yo self
67yo
20yo
18
Muscle, Tendon, Bone

• Bone-
• progressive loss of mineral density
• Muscle-
• sarcopenia
• loss of fiber number and size
• decreased flexibility
• Tendon/Ligament-
• loss of compliance
• stiffness
• decreased vascularity

19
Injury!

• 33 increase in injury from 91-98
• Highest in
• Cycling
• Basketball
• Baseball
• Running

20
Injury

• Performance decline attributed to increased rates
  of Orthopaedic Injury
• (Eskurza,02,Joyner, 93, Pollack, 97).
• Acute and overuse injury is 1 reason for
  stopping exercise.
• (Maharam, 99).
• The majority of 2001 Senior athletes experienced
  at least one More than 50 had experienced up
  to 5 injuries

The Reason Attenuated mechanical properties and
lower healing capacity of aging muscle and tendon
(Maharam, 99).
21
Injury

• 89 with gt 1 musculoskeletal injury since 50yo
• Foot and Ankle
• Knee
• Shoulder
• Lower back
• Mechanism 60 overuse 23 falls
• 54 competition/36 practice
• 51 RICE
• 1/3 sought MD and 12 required surgery

22
Osteoarthritis
23
Osteoarthritis

• Common-
• 12.1 of Americans (21 million people)
• 50 of people gt 65yo
• lt45yo-men/ gt45yo-women
• Arthritis care 72 billion/year
• Second only to CV as primary dx resulting in
  disability in the US
• Many causes but most often termed
  degenerative or wear and tear
• Cartilage wear
• Water
• Collagen
• Proteoglycans
• Chondrocytes
• Loss of cartilage leads to
• altered loads across the join
• bone changes shape/osteophytes.

24
How does OA affect people?

• Physical
• s/s- pain, stiffness, swelling, crunching,
  increased with activity
• Injury
• Lifestyle
• Limitations in mobility
• Decreased participation in lifestyle
• Depression
• anxiety
• Financial
• Treatment costs
• Lost wages

25
Osteoarthritis- 15men women

• INCREASED
• Age (plt0.001)
• 9x gt hip/ hand OA (plt.05)
• 2xgt LBP, neck pain
• anemia, ulcers
• Steroid/ pain med use (plt.05)
• Knee / back surgery (plt.05)

Compared to NON-Arthritic peers
Greater incidence of injury ( 60 v- 49) since
50 yo (plt0.001) 2 x more likely to report gt 5
musculoskeletal injuries 3 x more likely to
report injuries about the knees (48 v- 18)
26
Injury and OAKnee OA predisposed Senior
Athletes to higher injury rates.

• The Reasons Injury and knee OA
• Quad weakness (Hassan, 01)
• Altered proprioception (Bennell, 03)
• Abnormal neuromuscular response may weaken muscle
  response and decrease efficacy of protective
  muscular reflexes.
• Muscle fatigue alters proprioception (Miura, 04)
• 54 of Senior Athlete injuries occurred during
  competition
• Loss of proprioception in one knee is accompanied
  by decreased proprioception in the contra lateral
  knee (Koralewicz, 02)

27
Treatment goals for OA

• Pain control
• Improved joint function
• Maintenance of active lifestyle
• Maintenance of body weight

28
Osteoarthritis a continuum of care

• Exercise-related care
• Range of motion
• Quad strength
• Proprioception/balance
• Agility
• Non-surgical management
• Weight management
• Non-RX pain relief
• Heat/cold
• Massage
• Medication
• NSAIDS
• Acetaminophen
• Joint fluid replacement
• Bracing
• Alternative/complementary therapies

• Surgical management
• Debridment- 60 symptomatic relief at 3 yrs
• Realignment
• resurfacing

29
What is joint replacement?
Realignment of leg axis Resurfacing of worn
cartilage
30
Meteoric Rise in Joint Replacements by 2030
TKA- 673 increase THA- 174 increase Aging
population Technology
31
(No Transcript)
32
Joint Replacement a new lease on activity

• Dispelling the myth
• Factors affecting exercise
• What activities are best

33
Sports and Arthroplasty

• TKA
• Aerobics
• Cycling
• Dancing
• Golf
• Horseback riding
• Skiing
• Walking
• Swimming
• tennis

• THA
• Aerobics
• Cycling
• Dancing
• Golf
• Swimming
• Tennis
• Walking

34
Surgeon General- Richard Carmona

• We are at a cross roads in our nation. We are
  standing at the corner of health and disease.
  Are we going to sentence ourselves to being a
  society defined by obesity and disease? Or are
  we going to choose to be a nation of health and
  vitality?
• The direction could be influenced by
• the stroke of a physicians pen.

35
Exercise Prescription

• Vonda J. Wright, M.D.
• Name Booming Senior
• Hip/Knee ROM
• Lower Extremity Strength-focus on Quads/Hip
  flexors
• Proprioception/balance training

36
Thank you