Why do so many boomers suffer knee, hip arthritis when our forebears didn’t?

knees-300x81Although grandma and grandpa and even older ancestors before them didn’t live as long nor usually as well as many of us do, they still can provide valuable insights into how modern Americans can avoid painful debilitation that now leads to some of the most commonly performed surgeries on seniors.

Want to avoid an inconvenient, costly knee or hip replacement?

Keep your weight down and keep moving—two steps that researchers say may have helped reduce the prevalence of the joint rheumatoid arthritis (RA) that pushes tens of thousands of baby boomers each year to seek medical treatment, up to and including knee and hip procedures that cost taxpayers billions of dollars through the Medicare and Medicaid health programs.

Sure, the boomers have been one of the largest demographic groups in U.S. history (until millennials recently surpassed them) but researchers launched their study, published in Proceedings of the National Academy of Sciences, when they began to ask why RA seemed to have burgeoned among this aging group in recent decades.

Though arthritis has afflicted humans for eons, its diagnosed prevalence has doubled just since the middle of the 20th century, the researchers found, based on, among other things, a scrutiny of more than 2,500 skeletons. Most of the bones belonged to middle-aged and older Americans who lived and died in two periods, between 1905 and 1940, and from 1976 to 2015. Researchers also studied skeletons of Native Americans, some of whom lived 300 to 6,000 years ago.

The experts, including human evolutionary biologists, paleoanthropologists, biomechanists, and bioarcheologists, determined if subjects suffered arthritis by searching for smooth patches on bone, indicating bone on bone wear and where cartilage or other cushioning tissue had disintegrated, as occurs in RA.

Even factoring for health improvements like longevity, and correcting for body mass and age, the researchers were surprised to find knee arthritis rose from 6 percent to 16 percent, with even Native Americans—who often didn’t show signs of the disease—seeing their RA incidences rise to 8 percent.

Medical scientists long have blamed weight woes for much of Americans’ joint problems, as 36.5 percent of us are now deemed obese. It clearly is a big factor. But the new research suggests that our knee and hip issues may be more complex.

Our sedentary lives may be major contributors. Conventional wisdom may hold that our forbearers strenuous existence, with lots of walking, lifting, and carrying, wore out their joints. It may have done the opposite—the steady, sustained stress kept bones and joint healthier than what contemporary Americans experience by sitting around at desks, tapping away all day and night at computing devices. Moreover, we may also may be harming ourselves and our joints with the games we play: Sports injuries and incorrect rehabilitation of them may be adding to Americans’ hip and knee woes.

In my practice, I see the harms that patients suffer while seeking medical services, including knee and hip surgeries. Yes, these procedures are performed so often now that many doctors and hospitals have improved them, and made them a better option than patients’ suffering chronic, unrelieved pain and discomfort, seemingly with every step. Make no mistake, though: these procedures still are significant, invasive, painful, and they carry real risk, as does every medical service.

I regret that Uncle Sam—actually Tom Price, an orthopedist and the head of the federal Health and Human Services agency—also may be moving to make these and some other important and oft-performed medical procedures much more inconvenient, inefficient, and potentially costly.

The Obama Administration, especially under the Affordable Care Act, had pushed medical providers to get their act together, to work more closely to develop not multiple charges but a single cost for surgeries, like knee and hip replacement. Hospitals took the point, and Medicare and Medicaid officials, as well as surgeons, anesthesiologists, skilled nursing facilities, followed them in figuring what an appropriate “bundled” payment might be, say, to fix a knee. That’s what Uncle Sam would pay. The patient and the government got one bill, not a blizzard of then, with several coming from each provider.

Many doctors and hospitals complained that this experimental reform was complicated and time-consuming for them to make work. But advocates said bundled payments, accountable care organizations, and other ACA initiatives were reducing costs and making medical systems more efficient: By analogy, in a room full of used car dealers, when there’s one lump sum to be split, it became less likely that anyone popped up with undercoating deals and ticky-tacky upcharges.

With health care costing the nation more than $3 trillion a year, we need to ensure that, as reformers insist, doctors, hospitals, and other providers offer us value in our care, not just zip us with fees for every service. Price says he wants time to evaluate bundled payments. We’re watching you, and our pocketbooks very closely, Dr. Price.

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