Joint Effort

The demographics of people getting joint replacements are changing—they’re younger than ever. For better or worse, Jackson Holers are a great case study.

By Molly Absolon

ROB HESS SAYS he was “this close” to calling for a wheelchair. One of the owners of Jackson Hole Mountain Guides and president of the American Mountain Guide Association’s board of directors, Hess was on his return journey from leading an ice-climbing clinic for aspiring guides in Canada when he found himself crippled by pain and unsure he would be able to walk between gates at the Denver airport. He gritted his teeth and limped through the terminal, dropping into his seat with relief when he arrived. It was a wakeup call. If Hess, fifty-seven, couldn’t walk, he couldn’t guide. If he couldn’t guide, his career was over.

“Being in chronic pain affects everyone around you,” says Hess. “I found myself questioning my existence, looking at what I did for a living and wondering if I would be able to continue.” Hip pain came on gradually for the accomplished mountain athlete and guide. Like so many others who find themselves with joint arthritis, he started noticing little things: He had trouble buckling his ski boots; he was stiff when he got out of bed in the morning; he couldn’t swing his leg up and over things. After a few years of the little stuff building up, the pain became serious enough that he was forced to give up ski guiding for a season. As his world shrank it became clear it was time to do something.

“I am super glad I did it,” Hess says, five years after he had his hip replaced. “People ask you, ‘Do you wish you’d done it sooner?’ I say, ‘You’ll know when it’s time.’ Your pain begins to progressively hamper your lifestyle. When you get to the point where it’s starting to shut you down, you’ll know.”

BETWEEN 1993 AND 2010, the number of total knee replacements in the United States more than tripled while that of total hip replacements doubled. Those numbers are expected to continue to rise. Nationally, the increase is attributed to a rise in obesity, but what’s going on around Jackson Hole is different—here it’s younger people, as well as fit baby boomers, who are having their joints replaced.

“It’s a matter of lifestyle,” says Dr. Maurice Brown, who performs joint replacements at the Teton Valley Hospital in Driggs, Idaho, as part of a team with Rexburg orthopedic surgeon Kevin Lee. “Every time you ski or play sports it’s a risk event. If people are more active, they are more likely to sustain an injury.”

Injuries to joints create more wear and tear and bone spurring, ultimately destroying the cushioning cartilage and leaving people with debilitating bone-on-bone pain. Many athletes can’t even recall when such an injury might have occurred. Hess remembers a hard ski turn in heavy snow that sent a shooting pain up through his hip. He might have torn his labrum—the ring of cartilage on the outside rim of the hip-joint socket—during that turn. Or he might not have. His hip might have been worn out by the miles and miles he spent on his feet during his forays into the mountains. Or there could have been some genetic predisposition that made him more susceptible to arthritis. Regardless, at fifty-two, his hip looked like that of a ninety-year old and he was ready to get his life back. “I feel like I was given a new lease on life,” Hess says. “I’m doing what I want to do at a reasonably high level. I wouldn’t have been able to do that without my new hip.”

Nationally, the increase in joint replacements is attributed to a rise in obesity, but what’s going on around Jackson Hole is different—here it’s younger people, as well as fit baby boomers, who are having their joints replaced.

Hess is part of a growing trend in joint replacement surgery. During the decade between 2000 and 2010 the U.S. National Center for Health Statistics recorded a 205 percent increase in the number of people between forty-five and fifty-four years old opting for total hip replacements, while the rate of total knee replacements nearly tripled for that same age group. Records aren’t available for younger patients.

Brown says that growth is a reflection of people’s refusal to slow down, as well as the revolutionary improvement in the prosthetics available for joint replacements. Technology has bumped the projected longevity for new hip and knee joints up to thirty years or more. “When I was doing my residency in 1995 we thought knee replacements would last ten years, so we wouldn’t do them until people could not walk,” Brown says. “Now we’ll do joint replacements on arthritic athletes who can only ski fifteen days a season instead of their normal one hundred. That’s a huge difference from not being able to walk three blocks.”

ASK AROUND JACKSON Hole and it doesn’t take long to find people who’ve had a joint or two replaced. You’ll see them backcountry skiing, biking, hiking, climbing, even guiding or ski patrolling. Take Wesley Bunch, who had a knee replaced when he was forty-two after a series of failed surgeries to fix a ski injury, and then had a hip replacement in 2012 at age forty-eight. Bunch has guided fifteen high-altitude expeditions since his hip surgery. This past winter he guided in Antarctica and on Aconcagua, the highest mountain in South America.

“I never knew I had a hip problem,” Bunch says. “Then I hiked up to Goodwin Lake [in the Gros Ventre Range] and couldn’t make it back to the car. I had to crawl.” Like Hess, Bunch’s guiding depended on his mobility and his artificial joints have prolonged his career.

But it isn’t only professional guides who benefit from the absence of pain and the ability to move. Deb Frauson, executive assistant to the superintendent of Grand Teton National Park, says her world had shrunk to a hundred yards before her bilateral knee replacement, which she had done in June 2017. “Five years ago I was hiking up Mount Taylor in the Tetons,” she says. “Last year I thought I’d never hike again. My whole world had become smaller. Now it’s opening up in terms of potential. It will take time and I’ll have to figure out my limitations, but it’s cool to find out you can be physical again after being so debilitated.”

The desire to continue outdoor pursuits “represents a classic Jackson Hole patient,” Dr. Angus Goetz told the Jackson Hole News&Guide last October. Goetz does as many as five replacement surgeries at St. John’s Medical Center on an operating day. For many patients the positive results are evident immediately.
Brown says there have been studies that look at the outcomes of joint replacement surgeries in terms of their cost benefits to society. “These are kind of heartless economic studies,” he says. “But they do show that patients see huge improvements that are a benefit to society. Instead of leaving someone in pain and unhappy, you fix their joint and they can return to work and their quality of life is much improved. Heart surgery followed by joint replacements have the highest positive return on society.”

“I never knew I had a hip problem. Then I hiked up to Goodwin Lake [in the Gros Ventre Range] and couldn’t make it back to the car. I had to crawl.”

– Wesley Bunch, High-altitude expedition guide

THIS IS NOT saying that joint replacements should be taken lightly. The surgeries are brutal and violent, using drills, clamps, saws, and spreaders to cut the bone and clean out the joint. Rob Marin, of Driggs, who had his hip replaced six years ago when he was forty-nine, says he made the mistake of watching a video of a hip replacement surgery before his own. “That really got to me,” Marin says. “It’s the surgical version of carpentry. It’s pretty savage. Those guys [the doctors] are sweating.”

Complications are rare but not unheard of. Marin ended up with some internal bleeding and eventually his surgeon had to reopen his incision to drain the wound, but overall Marin feels his quality of life is much improved. “People’s expectations can be pretty high,” says Dan Streubel, a physical therapist in Driggs who has helped rehab countless joint replacement patients. “It’s not restoring a joint to the way it was in your thirties, but it does improve on your current condition. You can be active for a long time with some caveats. For example, you shouldn’t expect to be jumping or pivoting quickly on an artificial joint.”

Streubel and Crystal Wright of Wright Training in Jackson say that you can improve your outcomes by going into joint replacement surgery as fit and strong as possible, and then follow up with rehab. According to Streubel, 80 percent of one’s recovery takes place during the first three to six months, with the remaining 20 percent taking place in the first year. Where he sees people falter is when they fail to continue to strengthen their new joint. Wright, who has worked with dozens of people both before and after joint replacement, says, “There’s a lot of work to do after surgery. Rehab is so important and then it’s important to move on to strengthening. Without these things people may still have a lot of pain.

“People also need to be careful with impact and with overusing the good leg in the process,” she adds. “There is so much you can do to balance out your body: strengthening, Pilates, yoga … but that was less emphasized in the past.”

Hess says his experience verifies Streubel’s and Wright’s recommendations. “I’d been training at Mountain Athlete [now Mountain Tactical Institute] before my surgery,” he says. “But in anticipation of surgery [Mountain Tactical Institute owner] Rob Shaul helped me with a program to up the ante and to focus on the core to strengthen as much as possible all the supporting muscles for the hips to make my rehab as seamless as possible.”

“Two weeks after surgery I returned to training. Rob helped me work around my hip,” Hess says. “I was hiking and climbing high in the Tetons in twelve weeks. Thanks to discipline, hard work, and a little help from some friends—especially Rob—I was basically given a new lease on life. I’ve been able to go back to mountain guiding and ski guiding and my way of life with relative ease.”

Kees Brenninkmeyer Foundation

In the middle of his heli-ski season in Alaska, guide Kees Brenninkmeyer injured his knee. He limped through a couple more weeks of work, but it was clear the knee needed surgery. Brenninkmeyer was able to afford the best surgical center he could find: the Steadman Clinic in Vail, Colorado, which is known for helping injured athletes return to their careers. His surgery was successful, and he realized after his recovery that many of his colleagues did not have the financial resources he did. For them, a similar injury could jeopardize or even end their careers.

In 2007, Brenninkmeyer and his girlfriend died in a mountaineering accident. In his honor, his family established the Kees Brenninkmeyer Foundation, whose mission is to financially assist injured alpine guides, ski patrollers, and instructors who require surgery to continue their careers. The application for assistance is rigorous, but once accepted, an individual’s medical expenses are completely covered.

In Jackson Hole, many mountain athletes, including Wesley Bunch, Rob Hess, Zahan Billimoria, Renny Jackson, Maura Longdon, and Forrest McCarthy, have benefitted from the foundation’s generosity. They haven’t all required joint replacements, but they have all been able to rebound from potentially career-ending injuries to continue to guide, instruct, and patrol in the Tetons and beyond. keesbfoundation.org