Richard Berger, MD at Midwest Orthopaedics at Rush talks about a new, minimally-invasive way to perform knee replacements.
Interview conducted by Ivanhoe Broadcast News in 2024.
There seems to be a nice segue, younger patients getting knee and hip replacement. Is there a trend in the patients getting younger?
Berger: Patients are getting younger because we’re simply more active. We’re beating up our joints more, so we’re getting earlier arthritis. And unlike previous generations that were okay with not doing things, okay with having a wheelchair or a walker or just not doing the things they wanted to do, this generation doesn’t want to do that, which is great. In addition, now we realize that taking some of these medications long term aren’t good either. So now we have people who want to be active, don’t want to take medications and now have earlier arthritis. They’re simply getting joint replacements earlier and earlier. The average age of the patient I operate on is 52, much younger than you think. But that means I operate on some older patients up to 103, but I’ve also operated on patients in their 40’s, 30’s, 20’s, even teens.
Is there a common denominator for those folks, or not necessarily?
Berger: There’s no real common denominator other than patients being younger. We see patients who have had injuries, but also patients who just genetically have bad genes and are getting arthritis earlier. They don’t want to live with their pain and disability that maybe 50 years was okay to do, and maybe you took some pills, and you didn’t do as much. This generation doesn’t want to do that. They want to stay active. What I’m lucky enough to do is to see these people and allow them to continue to be active. Whether it’s to run a marathon, take a walk around the block, or just go up and down and do the laundry in the evening – patients want to do what they want to do, and I’m providing them the mobility and pain relief to do those things.
What are some reasons a young person could be prone to a knee replacement?
Berger: Genetics is really important. It actually turns out that genetics is so much more important than we think. We think everything’s wear and tear, what we do, not so much. Turns out that you can’t pick your parents, but you wish you could because sometimes our parents just give us bad genes and our cartilage just wears out. There’s something that’s called hip dysplasia, which is very common and happens in about 20 percent of people. That’s where the hip wasn’t quite formed normally, like tires on your car that aren’t put on right, wear out faster, hips that aren’t formed right, simply wear out faster, no matter what you do.
Is that a genetic thing?
Berger: That’s a genetic thing. In addition, the cartilage, how strong it is, and how it can repair itself is purely a genetic thing. If you have good cartilage, then you’re probably never going to get arthritis. If you have bad cartilage, no matter what you do, you’re going to get arthritis.
More activity, you mentioned that that’s a factor?
Berger: People are more active now to begin with. They get more injuries. They experience additional wear and tear, but more importantly, they want to stay active. In previous generations, when you got arthritis, you simply became less active. You didn’t do as much. Today’s people want to do more things. They don’t want to let their pain and disability slow them down. They want to treat it. They don’t want to pop pills either.
Do you think that the activity can create more wear and tear?
Berger: Yes. The pounding of our joints creates wear and tear, increased weight creates wear and tear, and that allows you to get arthritis, and I can help you by fixing it.
Are competitive athletes more inclined to have hip and knee issues because of all the pounding and the wear and tear?
Berger: It turns out that competitive athletes, not football players, but other competitive athletes that don’t get hurt and injured, actually have less arthritis. Because their joints work better, because their muscles are driving that joint in really a perfect way that therefore, you get less arthritis. It’s the weekend warriors that beat up their joints, but don’t do it quite in the right way that ends up probably getting a little bit more arthritis.
You talked about the longevity of implants, we can discuss that. You’re saying that because people are getting it younger, they need to keep them longer. You don’t want to have a revision at 50, right?
Berger: Two things happen as we begin to put implants in younger people. One is, they, of course, live longer. That’s pretty obvious. But number two is what you don’t realize is that, no matter how active you are at 50, you’re more active at 40, more active at 30. So you’re just going to put more wear and tear on your joints when you’re 30 or 40 or 50 compared to 70 or 80 or 90. Therefore, the number of years doesn’t quite correlate. Because it’s the activity you’re putting on, not the number of years. As we do younger patients, we want the prosthesis to be more durable.
Are patients starting to get implants or joint replacement younger because of improved surgical procedures?
Bergner: Yes. I think a couple of things. First, I think part of it is being driven by simply patients not wanting to be disabled from arthritis. But two is now they realize that we’re doing so much of a better job with the surgery. One is if you have a knee replacement, for example, used to be out for months and months. You come to see me, you’ll be at the hospital in three hours, you’ll be back driving and back to work if you want to be in a week. You don’t have to put in all this time to get the surgery done. Two is that the joints are simply lasting longer. Back, many years ago, they didn’t last very long. If you were young, you didn’t want to get a joint replacement. Now it’s lasting longer. It’s okay to get a joint replacement. In addition, the pieces are modular. They pop on, they pop off. If we put it in someone young like 15, 20 years, 25 years, the plastic piece wears out, we can just go in and pop it out and pop a new piece in, and it’s nothing to do in a very short recovery.
What about obesity? Is that a factor at all in patients starting younger?
Berger: It turns out that obesity significantly affects knee arthritis. As the population has gotten a little heavier, we’re seeing more knee arthritis. Obesity surprisingly doesn’t affect hip arthritis. Hip arthritis is much more genetic than anything else. Knee arthritis is a little bit more wear and tear and a little bit more other factors such as obesity.
We talked about how they don’t want to give up their active lifestyle. According to a national study by the ASS, the average age of hip replacements has stuck down from over 66 to slightly under 65. Knee replacement patients, average age 66 down from 68. What would you guess your average age is? You told us 52. Are you seeing more patients with hip dysplasia, or is it’s same that seems to be a constant?
Berger: Hip dysplasia happens in about 20 percent of the population. We see a little bit more arthritis in patients with hip dysplasia. We see a little bit more patients coming to see me with hip dysplasia. It’s probably about 25 or 30 percent of the hips I operate on have dysplasia. In case you’re wondering, we fix the dysplasia when we do the surgery, so they no longer have dysplasia. But that’s one of the things that we’re seeing in younger and younger patients. Again, the average age of the patients I operate on is 52, younger than a lot of people because I think young people seek me out because they want a really quick recovery. They want more longevity. That’s what I’m able to provide for them.
Do you think the condition of hip dysplasia is something that’s growing or is that same as it’s ever been in time?
Berger: It appears as though hip dysplasia is stable in the population. It’s about 20 percent. But again, as we’re getting more active, we’re just seeing younger patients come in with hip dysplasia because they don’t want to tolerate their pain and their disability.
There is an estimated 600 percent increase in knee replacements and 200 percent increase by 2030. What do you attribute that to?
Berger: More people needing hip knees is that the baby boomers are simply aging. There was a relative decrease in the population during the Depression and during World War II. That’s the greatest generation that we have seen and that we’re taken care of. But now the baby boomers are coming, which is almost twice that population. The baby boomers are getting arthritis more. The baby boomers simply don’t want to live with arthritis as the last generation might have, and they want to continue to be active. They want to continue to do what they’re doing. So we’re seeing more people who want to be more active, who are unwilling to live their life with a cane, on the bench. They want to be a participant. They want to play their pickle ball. They want to go play tennis. They want to play golf. They want to run. They want to do triathlons. They want to do everything, and they’re unwilling to take pills and unwilling to have a cane.
Is there a shortage of joint replacement physicians now, do you feel?
Berger: Right now, there’s probably just a little shortage of joint replacement surgeons. But in the next decade, there’s going to be a big shortage because the same number of people are going into joint replacement, which is great. But the population with the baby boomers coming is going to explode with the number of people needing joint replacements. Some numbers say two or three to six times the number of joint replacements are going to be needed a decade from now as we’re doing now, and we simply don’t have the surgeons to do that.
What will happen if there are more people? What do you see happening?
Berger: Fortunately, as we’re getting better at doing joint replacement, actually the surgeries are faster. As we’re going to outpatient centers and as hospitals are adapting, we’re able actually to do more surgeries per day. That’s going to help some. Ultimately, there’s just going to be a shortage, and it’s going to be harder to get a joint replacement, possibly unfortunately, a longer wait. But I hope that’s not true.
You don’t think it’s because fewer people are going into orthopedics, do you? It’s just more of a numbers game? It is enough?
Berger: No. Twice as many people are applying to orthopedics as there are spots in the country. We are turning away people in droves, unfortunately.
END OF INTERVIEW
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