THE AGING of the baby-boom generation has most experts predicting a tidal wave of demand in orthopedics.

Baby boomers are the first generation to have participated in recreational sports in large numbers. And all that added wear on their bodies has taken a toll, experts say.

The Inquirer asked two orthopedic surgeons to discuss orthopedic issues faced by the baby-boom generation. Nicholas DiNubile, 58, who specializes in sports medicine, is in private practice in Havertown and is the author of FrameWork: Your 7-Step Program for Healthy Muscles, Bones, and Joints. Dino Nicol DeJesus, 34, is an orthopedic surgeon at Cooper University Hospital in Camden.

What are the most common orthopedic problems for which you are seeing baby boomers?

Rotator-cuff problems in the shoulder "are really common, like gray hair and wrinkles," DiNubile said.

Tendon-related injuries, such as golfer's elbow, are also common, he said, and boomers are displaying the wear and tear of aging in their hips and knees with lots of osteoarthritis.

According to DeJesus, osteoarthritis is the most common degenerative joint disease, and the biggest growth in joint replacement has been in the 45-to-55 age range.

The weight-bearing joints - hips and knees - are where many arthritis sufferers feel the pain and opt to seek relief with a range of treatments, often culminating in joint-replacement surgery, he said. The lower back is also a problem area for many people as they age, he said.

How can you lower the risk of going under the knife?

DeJesus noted that there are many options short of surgery, including injections of corticosteroids to address acute flare-ups of arthritis, as well as injectable, bioengineered lubricants.

Exercise, especially low-impact aerobic exercise, can help, he said, and losing weight can ease the pain tremendously.

DiNubile also stressed the importance of diet and nutrition for middle-age people. Diet, of course, affects weight, but a good Mediterranean diet with lots of whole grains, fruits and vegetables can also affect your skeletal health, he said.

"You can get away with a lot more during the first half of your life than the second half," he said.

What about fish oil and other dietary supplements?

Dietary supplements such as fish oil can be really helpful, DiNubile said.

"Omega 3s are a profound anti-inflammatory," he said. And if patients feel as though they benefit from glucosamine and chondroitin, then they are also OK to take, he said.

DeJesus isn't as big a fan of supplements but said there is no harm in trying them. "What I tell patients is to try it out, and if it doesn't work, stop it," he said.

Physical therapy can cure a lot of ills. Shouldn't hip and knee patients start there first?

DeJesus said that physical therapy can be useful, particularly for couch potatoes who are not used to exercising and don't know how to do it correctly. Even for active patients who have joint pain from arthritis, DeJesus said, physical therapists can help develop an exercise regimen that builds the muscles without exacerbating the problem areas.

DiNubile also noted that physical therapy can play a key role in strengthening "weak links" in people who are showing the signs of arthritis and other muscular-skeletal problems associated with aging.

"If you can resolve a problem [by stretching or other means], that is your first choice," he said. "But if you can't resolve it, toughen it with either exercise or rehabilitation."

When do you know it is time to consider joint replacement?

"Pain is the determining factor," DeJesus said.

Joint-replacement operations are elective surgeries that address the pain caused by osteoarthritis, he said. So for patients whose pain is so bad that it interferes with their ability to perform activities of daily life, it is time to consider this option, he said.

That point, however, varies from patient to patient.

"Pain is subjective; patients need to make the decision on surgery themselves," he said. "What you may be perceiving as a lot of pain could be nothing for another patient."

DiNubile said patients should "try everything else first" before considering a joint replacement.

After you have tried weight loss, strengthening, supplements and injectable lubricants, then "you need the parts department," he said.

When you make the decision for surgery, do your research, DiNubile advised. Look for surgeons who have done a lot of the operations because experience matters in surgery.

Also, find a surgeon you are comfortable with and who fits your style, he said.

DiNubile said key questions should be, "What can you expect after the surgery?" and "Can you get an appointment after it is done?"

What is a good source of information on these issues?

Both doctors recommend that patients visit the website of the American Academy of Orthopaedic Surgeons.

Patients can browse the academy's site, which provides a range of information by body part, at

For those seeking information on knee issues, the academy has produced

Contact reporter Josh Goldstein via science and medicine editor Karl Stark at