Generation B: Doc, Make Me New Again

The New York Times—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.

"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 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.

Read the full story at NYTimes.com.