Kneed Analysis

By Published on .

Weekend warriors may break some bones, but Docs are there to set them.

This fall, as kids and their fathers (and mothers) head outside to toss the pigskin or kick around the soccer ball, thousands of orthopedic surgeons across the country will be standing by, ready to answer the call. Or maybe the cries.

Each year, more than 2.3 million procedures are performed in the field of sports medicine - an $860 million industry, according to U.S. Bancorp Piper Jaffray. And you can bet most of those going under the knife aren't professional athletes. Aging baby boomers are the high achievers, and they are expected to help maintain annual growth rates between 8 percent and 10 percent through 2002 for the industry, researchers say. That's not only because of the traditional wear and tear that comes with the aging process, but also because of the size of the cohort, and the fact that boomers are more active than the generations that preceded them.

Knees account for 24.3 percent of all orthopedic procedures and are the field's most commonly treated body part. In 1996, 245,000 total knee replacements were performed, reports the American Association of Orthopaedic Surgeons (AAOS), at an average cost of $28,340. Got any stock in Ace bandages? The AAOS projects that by 2030, we'll see an 85 percent increase in the number of these procedures performed - barring any miraculous breakthroughs in preventative treatment, of course.

Overall, Westerners are most likely of all Americans to visit an orthopedic surgeon - 17.6 visits per 100 persons - but Southerners account for the largest percentage of all visits to orthopedic surgeons: 30 percent.

"Residents of sunshine states like Arizona and California are more likely to have surgery because they are traditionally more active," says analyst Tyler Lipschultz of U.S. Bancorp Piper Jaffray.

For the same reason, ski states such as Idaho and Nevada are becoming hot beds for the bedridden. "Any sport that involves a lot of twisting and turning is more likely to cause injury," Lipschultz warns.

In addition, expect to find higher levels of surgeries performed in major population centers, as people from rural counties with fewer skilled surgeons come to town for treatment. "Little Rock has a lot of really good surgeons and so people from the outlying and rural areas flow to Little Rock for surgery," Lipschultz says.

Orthopedic patients come in all ages, but there's a sharp rise in visits to Dr. Sawbones once people turn 45. According to a 1998-99 report from the National Center for Health Statistics, people ages 25 to 44 had an annual rate of 13.8 visits per 100 persons to orthopedic surgeons, versus 22.4 visits per 100 for those aged 45 to 64. The rate for those 65 to 74 was slightly higher, 24.6.

One company that is going after this emerging "active seniors" market is Bally's Total Fitness, the largest publicly owned health and fitness club in the nation. Dr. Paul Kennedy, assistant vice president of personal training services at Bally's, reports that the health club has diversified its program offerings, and will include sports-medicine centers (to dispense doctor-recommended physical therapy) in 36 of its 350 locations by year's end, more personal trainers, and a variety of classes open to clients of all age and activity levels. Smart thinking: Four years ago, the average Bally's member was in their mid to upper 20s. Today the average member is 35 to 36 years old.

Not surprisingly, the people over 35 - the ones who will be driving the orthopedic surgery boom in the next century - are increasing their participation rate in nearly half of the activities reported by the National Sporting Goods Association. Leading the way is "exercising with equipment," up 4.5 percent from 1991 to 1996, by people over 35. Also growing is participation in basketball, football, and soccer, which happen to rank one, three, and five, respectively, as activities responsible for the most commonly treated activity-related injuries in hospital emergency departments, according to the U.S. Consumer Product Safety Commission.

Lisa Doty, director of communications for the American Orthopaedic Society for Sports Medicine, says the number of sports injuries among those between the ages of 40 and 60 has increased 50 percent to 60 percent in the past ten years. And the boomers can't wait to get back to whatever they were doing before their injury, Doty says. "They're not content being told, `You're done.' The same is true for the over-60 population."

Dr. Robert Wilson, an orthopedic surgeon in the retirement community of Sun City, Arizona, sees patients - most of whom are over 55 - who are runners, cyclists, dancers, golfers, and fast-pitch softball players. "We don't use the words `You're old, go sit in a chair,'" Wilson says. "Instead, we try to tell people what they can do." There's no way to predict who is going to have a problem, Wilson adds, "but the frequency [of injury] increases markedly with age. Just the fact that people are remaining active [and] living longer requires `the machine' to remain active for a longer time."

Helping people recover after surgery is becoming big business as well. The "Fastest Growing Occupations" list, put out by the U.S. Census Bureau, indicates that by 2006 there will be 81,000 more physical therapists than in 1996, an increase of 71 percent. Employment for physical and corrective therapy assistants and aids is expected to grow 79 percent in the same period, adding more than 66,000 new jobs.

Merry Lester, president of Denver Physical Therapy, says her business has seen substantial growth in recent years. But is physical therapy riding the wave of the orthopedic boom, or simply experiencing a boom of its own? "I don't think one is necessarily related to the other," Lester says. "I think the growth has been parallel. Sometimes I send clients to therapy; sometimes I treat them after therapy."

Bally's is trying to capitalize on the injury market as well, helping clients ease the transition from the hospital to the gym. "We take the person in physical therapy and introduce them to one of our personal trainers once they are released," Kennedy says.

Indeed, with advances in orthopedics providing aging Americans with a kind of fountain of youth, don't be surprised if grandpa and grandson get matching inline skates for Christmas.

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