# Attention aging active seniors: They can rebuild you--or your knees and hips, anyway.

And they do. SLO seniors get more knee and hip replacements than just about anybody else in the state, according to Medicare data compiled by the Dartmouth Atlas.

The Atlas tracks the distribution of medical resources nationwide, and San Luis Obispo's region stands out in both procedures.

It's the top place in the state for hip replacements, with 4.35 for every 1,000 Medicare enrollees. And it's second only to the Chico area for knee replacements, with 8.47 for every 1,000.

Anecdotally, area doctors say the trend likely continues for those younger than 65, although there aren't the same sort of numbers available.

The rates of each procedure are also high as compared to the nation as a whole, although for each procedure, numbers seem to be highest for a cluster of Midwestern cities. Sioux City, Iowa, for example, is tops nationwide for hip replacements, with 5.36 per 1,000, and second for knee replacements, with 12.03 per 1,000.

So what's behind the local numbers?

There's no one clear answer, but area orthopedic surgeons suspect it has to do with having a population of active, older seniors who have the education and money to both ask for help and get it.

"You have the person that's lived on the Central Coast and has been hiking and biking and is kind of outdoorsy," said Dr. Otto Schueckler, an orthopedic surgeon with Central Coast Orthopedics in San Luis Obispo. "People are outside and they realize--hey, it hurts when I walk down the Bob Trail."

Word of mouth may also be a factor, he noted after one member of a hiking group finds success with a procedure, others may follow his lead.

# Yet the rates may also be boosted by advertising. Like laser eye surgeries, some local physicians market their expertise in the area of hip and knee replacements directly to consumers.

And certain medical device makers also advertise directly to consumers, touting their products or the benefits of certain procedures.

Celebrities are also in the mix. Disgraced professional cyclist Floyd Landis toured the state last year along the route of the Tour of California--including a stop in San Luis Obispo--to promote a particular hip resurfacing system. One maker of artificial knees features Mary Lou Retton in advertisements.

Physicians have long become accustomed to the "ask your doctor" commercials touting cures for heartburn, impotence, high cholesterol, and insomnia. Previously banned, those advertisements have exploded in the last decade, and critics blame them for unnecessarily inflating the usage of certain drugs, particularly brand-name medicines. They also say that the commercials provide too little information on risks.

More recently, physicians have been hearing from patients responding to a new marketing trend touting specific implantable medical devices.

Such direct-to-consumer advertising has been a controversy within the medical community, and the American Association of Orthopedic Surgeons has an official position urging caution so people don't seek unnecessary or inappropriate procedures, although its position also holds that such advertising can be beneficial when it alerts people to helpful procedures they may not have been aware of.

In December, Consumers Union petitioned the FDA, requesting that such ads include more information about the risks of surgery, including infections and the chance that devices can fail.

Schueckler said that his group doesn't do direct-to-consumer ads, but does participate in certain community education events, such as those sponsored by local hospitals.

Area orthopedic surgeon Dr. Daniel Woods, who is also with Central Coast Orthopedics and performed more than 100 knee replacement surgeries in 2006, said direct-to-consumer advertising is controversial within the field, but seems to work.

"People see Mary Lou Retton advertising a knee replacement or Jack Nicklaus talking about hip replacement, and they do ask about it," he said.

Whatever the cause of the high number of hip and knee replacements locally, it's a trend that's likely only to increase. San Luis Obispo's population is aging, in large part by retirees moving to the area.

"People who have been used to being active, when they start losing their ability to be active, they're not content," Woods said. "We're going to see these procedures performed more and more as the Baby Boomers get to that point."

Managing Editor Patrick Howe could use a nice, new shoulder. He can be reached at [email protected].