By MICHAEL WINERIP
Published: February 13, 2009
DR. STEPHEN J. O’BRIEN, an orthopedic surgeon, had his patient, Jay MacDonald, 52, lie on the examining table and bend his right knee back toward his chest to test for flexibility. The doctor had replaced Mr. MacDonald’s knee five weeks earlier and wanted to see how far beyond 90 degrees the knee would bend.
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Josh Haner/The New York Times
“You passed 110, pal,” Dr. O’Brien said. “That’s awesome.”
“Oh, yeah,” said Mr. MacDonald, a media investment banker. “I’m up to 115, 117 — most don’t get past 110 in the first six weeks.”
“Excellent,” Dr. O’Brien said. “You should start doing the exercise bike.”
“Already doing it,” Mr. MacDonald said. “Two weeks now.”
After replacement surgery on one knee, arthroscopic surgery for torn A.C.L.’s in both knees (skiing, running, tennis), rotator cuff surgery on his right shoulder (surfing, golfing, snowboarding) and an assortment of minor catastrophes (“the last was a freak — I popped a tendon in my left arm doing curls in the gym”), Mr. MacDonald, like a lot of other men his age, has become one of the world’s leading experts on why he keeps breaking down and how he puts himself back together.
A few years ago, when his right shoulder went (“snowboarding in Vail”), he begged Dr. O’Brien, a sports medicine specialist, to operate.
Dr. O’Brien told him the shoulder tear was severe, the likelihood of success too low. The doctor said that his colleagues at the Hospital for Special Surgery in Manhattan have about a 60 percent success rate on such surgeries, which he described as “not good odds for our world,” and that some national studies have shown failure rates as high as 90 percent.
“I said, ‘You have to,’ ” Mr. MacDonald recalled. “I want my life back. I want to surf — I’ve been surfing since I was 8. I do big waves, 16-footers. I can’t stop just because of a rotator cuff.”
Dr. O’Brien said that he was skeptical, but that he went ahead for several reasons: Mr. MacDonald is fit; he works hard at physical therapy; he is bright and understood the risks; and, as a longtime patient with whom he has had a close relationship, he was not likely to sue if the operation failed. “You balance a lot of things,” Dr. O’Brien said, “including not wanting to kill a person’s spirit.”
The surgery succeeded; Mr. MacDonald’s shoulder is again strong enough to paddle out.
“That was a wonderful feeling,” Dr. O’Brien said. “Like hitting a swish from half-court.”
“Farther back than that,” Mr. MacDonald said.
As they make their way through middle age, baby boomers — the first generation to widely embrace running and other forms of exercise as the path to good health and long life — are breaking down and being repaired at a record clip, having more surgeries sooner, and all the while pushing the frontiers of orthopedic medicine.
In 2006, 193,000 Americans age 45 to 64 had knee replacements, 39 percent of all such surgeries nationally, which was up from 35 percent in 2002, according to the American Academy of Orthopaedic Surgeons. So, too, for boomer hip replacements — 39 percent of the surgeries in 2006 were for patients 45 to 64, compared with 34 percent in 2002.
For years the conventional wisdom was to put off such surgery for as long as possible. But the hobbled, older patient who waited was more likely to be frail and overweight, to have high blood pressure and to develop back problems from compensating for the failing joint.
NOW that the pendulum has swung, the challenge for a surgeon like Dr. O’Brien (himself a 54-year-old former athlete who played football and baseball at Harvard) is to find the balance between what’s medically prudent and the determination of some of his boomer patients to keep going until they grind themselves into dust.
While he repeatedly urges moderation for those redone knees and shoulders — running 20 miles a week instead of 40, skiing green trails instead of the blacks — his patients often have their own ideas. “I don’t do double diamonds or moguls anymore,” said Sue Sacher, 61, who had her right knee replaced and will soon need to replace the left one, “but I can still ski blacks.”
Every day, Dr. O’Brien’s office fills with middle-age men and women determined to remain as athletic as they were as post-adolescents, men like Harry Packman, 50, a Manhattan lawyer who plays in three softball leagues (“I used to play in five, but I had to cut back”). Mr. Packman has had “roughly 16 surgeries” on his knees and shoulders since his first knee arthroscopy in his mid-20s, he said. He’s spent a lot of time in physical therapy; that’s where he met his third wife, who was working as an athletic trainer at a rehab center while he was rebuilding a back muscle torn playing touch football.
Mr. Packman is pretty much the Energizer Bunny. After surgery on his right shoulder in 1998, the normally right-handed shortstop played a must-win playoff game as a left-handed first baseman. After more surgery on the right shoulder in 2004, he mastered one-armed snow shoveling. “You just scoop it with the left and kick it off the shovel with your right foot,” he said. “It works pretty good.”
In December 2007, Mr. Packman had his left knee replaced (“I’d worn a hole in the knee — there was no cartilage left”). Within two weeks, he was doing leg squats with 150 pounds, eventually working up to 285 (“That’s 20 reps — presurgery I did 450”). In October 2008, playing shortstop right-handed, he helped his team win the 2008 Advertising Softball World Series in Phoenix, legging out an inside-the-park home run. “Plus, I scored from first on a single, which was even harder,” he said. “My knee’s 100 percent. It jiggles around a little, it makes noises, but it works.”
Dr. O’Brien said when he started as a surgeon 22 years ago “someone like Harry Packman wouldn’t have even been in my thought process.”
Nor would Robin Gold, 54 (tennis, biking, running, skiing, golfing, swimming), who does wildlife rehabilitation, along with her own Robin Gold rehabilitation, following 14 surgeries “basically for overtraining.”
Since 2007, it’s been her right elbow. “The first time, it was the lateral extensor tendon,” she said. Dr. O’Brien reattached it with screws and she resumed tennis. Then in November 2008, “I served a ball, felt a pop, and this time tore the medial flexor tendon in the same elbow,” she said. The medial flexor was reattached, and she’s in rehab again. “I expect to be back on the tennis court at the end of March,” she said. “I’m counting the days.”
Mr. MacDonald, whose right shoulder is now good for surfing but whose right knee is still in rehab, has scheduled a March 20 golf date.
Mr. Packman, whose left knee continues to function but whose right shoulder is about finished (“sometimes when I try throwing to first, the arm won’t come around and the ball goes to home plate”), is considering becoming a left-handed centerfielder.
They’re driven by all the things that drive Type A’s, from their own hyper wiring to memories of the dead. Mr. Packman said his father never played anything, smoked five packs a day and died of emphysema at 71. And Ms. Gold, who’s so busy rehabbing her right medial flexor, had a mother who never exercised, smoked and died at 64 from lung cancer. “Good incentive for a healthy life,” Ms. Gold said.
