Boning Up
Can advances in orthopedic medicine help the human body endure an extended lifespan?
by Bill Donahue

Special Section: Top Orthopedic Physicians 2011


On May 21, 2010, Montgomery County honored its resident centenarians—people who have lived to be 100 years old—at the First Annual Montgomery County Centenarian Luncheon. More than 30 local centenarians and their guests attended the event, which was held at Brittany Pointe Estates in Lansdale, and organizers were somewhat astonished not only by the turnout but also by the mobility of many attendees.


“We packed the room,” says Joanne Kline, executive director of the county’s Office of Aging and Adult Services, based in Norristown. “We were surprised we didn’t need as many wheelchairs as we thought we would. … One gentleman who came was 104, and he plays his violin every day. He just came walking right in with his daughter. It was remarkable.”


Preparations are already under way for the 2011 event, and population trends suggest attendance will far exceed the 30 or more honorees from the inaugural affair; more than 200 Montgomery County residents turned 100 or older last year, according to Kline. The United States, in fact, has more centenarians than any other country—nearly 70,500, according to a 2009 U.S. Bureau of the Census estimate—a population stoked by education, advancements in medicine and the ubiquity of long-term care facilities.  


“For the most part we are all going to be living longer,” says Dr. Nicholas DiNubile, a prominent orthopedic surgeon based in Havertown. “We’ve added more years to our lifespan in the past 100 years than we have throughout our entire history. But there’s a mismatch between longevity and the durability of our frames; evolution hasn’t caught up and won’t catch up for probably a million years.”


The point is, although Americans are living longer than ever, the human body has not kept pace—particularly, the bones, joints and other mechanics of the skeletal system. This unfortunate fact means Americans living into their so-called Golden Years often do so unable to enjoy them as they might have hoped—in some cases bound to a wheelchair or even confined to a bed. Taking preventive steps to “turn back the clock,” however, can keep such a fate from becoming inevitable.


“The key is keeping people active,” says DiNubile, author of the bestselling book “FrameWork: Your 7-Step Program for Healthy Muscles, Bones and Joints,” as well as executive producer of an award-winning PBS program, “Your Body’s FrameWork.” (Subsequent works through his publisher, Emmaus-based Rodale Books, include “FrameWork” volumes designed specifically for the knee, lower back and, in the near future, shoulder.) “Exercise is the closest thing to the fountain of youth that we’ve found.”


That’s as true for a 30- to 40-year-old as it is for a 60- or 70-year-old. By age 40, the metabolism has slowed, the frame has shown its first signs of muscle loss, and the body has begun to process food differently than it did when it was younger. Developing good habits by the time a person hits middle age—especially relating to exercise—can help ensure an improved lifestyle into the twilight years.


“I’m a big believer in prevention rather than intervention, and I think that’s the key to having a frame that lasts as long as you do,” he says. “When you get a little older, strength training becomes so much more important. For people 50 and older, especially women and the elderly, they need strength training more than the front line of the Eagles football team.”


‘A New Start’

But problems related to frame durability afflict people of all ages. Among younger populations, for example, the majority of orthopedic surgeries are performed on high-school and college-age athletes, such as football linemen with shoulder-instability issues or soccer players suffering tears of the anterior cruciate ligament.


“Athletic participation is at an all-time high, especially among women, so we’re seeing a higher incidence of injury,” says Dr. Anne Colton, an orthopedic surgeon with Broomall-based Surgical Orthopedic Associates, a division of Premier Orthopaedic & Sports Medicine Associates. “I also perform a lot of rotator-cuff surgeries as well; some of those are athletic injuries, but more are degenerative or from slips and falls from people over the age of 55 and 60.”


Advances in health care and technology can “fix” or at least mitigate some of these problems, but such progressive treatments are often prohibitively expensive—both for the individual and for the nation’s health-care system. One such technology is known as cartilage regeneration by way of “microfracture” surgery. Through this minimally invasive technique, surgeons create tiny fractures in the underlying bone, which spur the development of new cartilage. Only a handful of surgeons nationwide—including Colton and DiNubile—perform microfracture and other restorative procedures, such as chondrocyte transplantation on cartilage-worn knees.


In the transplantation procedure, healthy cartilage cells are extracted from a patient’s knee and sent to a third-party company such as Cambridge, Mass.-based Genzyme for regeneration. Once sufficiently cultured, the cells are then returned to the surgeon in a vial—worth an estimated $16,000, according to DiNubile—which are then re-implanted into the patient’s knee to re-grow the native cartilage and, after rehabilitation, improve one’s mobility.


It might sound more like science fiction than actual science, but regenerative procedures for human tissue have the potential to vastly change how Americans live, work and play. Slowing the widespread acceptance of regenerative medicine are stingy insurance companies, which often balk at said procedures because of their cost and complexity, and a seemingly reluctant U.S. Food and Drug Administration, which acts as the gatekeeper for regenerative-medicine products. Despite such barriers, industry watchdogs suggest the field will experience “explosive” growth over the next 15 years.


“It used to be that to fix injuries we would try to patch you up,” DiNubile says, “but regenerative medicine is right around the corner; we’re there now. Like a salamander re-growing its tail, we’ll be able to do things like re-grow disks, solve osteoporosis and give people a new start.”


‘Not an Option’

Americans should not rely solely on medical advances, however.


“The way we approach health care now is the same way we’ve been doing it for a long time in this country, and it does not put the onus on the individual,” DiNubile says. “You can’t expect everyone else to pay for your bad habits; it’s not a Wall Street bailout.”


A lifelong commitment to health, nutrition and exercise—beyond simply having a healthy heart and looking good in a swimsuit—can help people age gracefully … and actively. And even if injuries do strike, according to DiNubile, people need to adjust. DiNubile, for example, has maintained his status as a U.S. Professional Tennis Association-certified tennis player despite struggling with knee and back issues.


“The knee is a chronic problem, so I’ve had to change the way I strengthen my legs,” he says. “I can’t do squats or lunges, but I can play tennis again even though it hurts. … Being sedentary is not an option; it’s as dangerous to your health as smoking a pack [of cigarettes] a day. As you age, you’ve just got to be active differently and be smarter about it.”


DiNubile also stresses balance in workouts in order to avoid imbalances in the body caused by overworking or under-working muscle groups. A runner, for example, should consider taking up yoga, because running tends to create tightness in many muscles, which yoga can help relieve. Specifically, he suggests focusing on the “four corners” of exercise: strength, cardiovascular training, flexibility and core torso work.


“After the age of 40 or 50, these problems are bound to affect us,” he says. “Like gray hair and wrinkles, they’re out there, just waiting for us. … Staying active is one of the keys to keeping your frame younger and turning back the clock, turning back that odometer.”


Likewise, Dr. Colton, who is the head physician for the Philadelphia Independence professional women’s soccer team and several area high-school sports teams, tells all the athletes with whom she interacts to continually improve their strength and flexibility as a way to stay off the trainer’s table: “You can’t completely avoid injury, but you can be as strong and flexible as possible to lessen the likelihood [of injury]. … Absolutely, that advice applies to people as they age as much as it does to athletes.”


Beyond good exercise and nutrition habits, however, there’s also an intangible factor that can increase the likelihood of a long and spirited life, according to Kline from the Montgomery County Office of Aging and Adult Services.


“Attitude is incredibly important; a lot of it comes back to the individual,” she says. “One of the centenarians at our [2010] luncheon said it’s all about having joy in your life every day, so it’s about good attitude as well as good genetics.”