On May 31, Secretary of State John Kerry fell while cycling in France and broke his right femur (upper leg bone). He was riding slowly on level ground and struck a curb with the front wheel of his bicycle. His long history of competing in sports means that he probably has strong bones that should not have broken in a low-speed fall. However, his femur had been weakened by the steel rod placed inside the bone during hip replacement surgery.

The incidence of femoral fracture after hip replacement is only 0.25 percent without falling (J. Arthroplasty, 9: 511-519, 1994), but there is a 250 percent increased risk for fractures in 2.5 to 5 years after hip replacement surgery, compared to those who do not have hip disease (Arthritis Rheum, April, 2011;63(4):992-1001). Falling off a bike after a hip replacement puts a person at extremely high risk for a femoral fracture. Breaking a bone around a hip joint replacement weakens the bone so much that it may never heal normally. Kerry may be advised never again to follow his passion of riding a bike. He might want to switch to a racing tricycle, which would markedly reduce the risk of falling.

A Lifelong Exerciser
John Kerry has always exercised and competed in sports. He has always been a dedicated athlete with mediocre natural talent. In high school he made the varsity hockey team at St. Paul’s School in his senior year. That team went 0-10-1. During his presidential campaign, the news media was full of articles about his time at Yale where he played three sports, but the only varsity sport he played was soccer. He played hockey on the freshman team and on the junior varsity team in his senior year, and played junior varsity lacrosse.

During his adult life, he has been very active as a bicycle rider and hockey player and to a lesser degree as a runner, snowboarder, windsurfer, and kite-sailor. He ran the Boston Marathon in the 1970s; finished the 110-mile Pan-Massachusetts Challenge, a bicycle race, in 6 ½ hours; and competed successfully in hockey into his sixties.

Two Hip Replacements
Kerry attributes his 2009 replacements of both hips and his knee surgery in 2005 to trauma from playing hockey, other contact sports and running. While a congressman he had a major crash while skiing and also had to have surgery on his jaw when he crashed into a goalpost with his face.

Hip replacement and knee replacement surgeries have become commonplace but I always encourage people to put them off as long as possible. I think that you should not get your hip replaced until the pain is so constant that you can’t sleep at night. Be sure that you understand the possible consequences of a replacement joint:
• If you get an infection anywhere in your body and the germ gets into your bloodstream, it can get into the hip replacement which has no local immunity and can be very difficult to treat.
• If you fall, the bones surrounding the joint are weakened by the rods in them and you are at high risk for breaking that bone. Sometimes a broken femur in a hip replacement never heals properly.
• Once you have had joint replacement surgery, you should not run, jump or do any type of high-impact exercise since the force of your foot hitting the ground can loosen the joint replacement.

Why All People Should Exercise as They Age
Everyone loses muscle fibers with aging. The vastus medialis muscle in the front of your upper leg has 800,000 fibers in a 20 year old and only 200,000 fibers in a 60 year old. Aging weakens you no matter how much you exercise and increases your chances of falling. Your bones also become thinner and weaker with aging which increases your chances of breaking them. One in three people over 65 suffer major falls. More than 90 percent of broken hip bones occur in people over 60, and the United States has the highest rate of hip fractures in the world. Older women who break their hips are five times more likely to die within a year than women of the same age who don’t break a hip (Archives of Internal Medicine, September 26, 2011).

Exercise also sensitizes muscles to insulin, which lowers high blood sugar levels and helps to prevent diabetes. Since diabetes is the most common of the known causes of heart attacks, exercise along with a high-plant diet helps to prevent heart attacks.

Learning from John Kerry’s Story
• Everyone should exercise and it becomes more important to exercise as you age since aging weakens bones and muscles. Furthermore, the average North American gains five pounds per decade after age 20, and regular exercise helps you avoid weight gain. Obesity increases risk for diabetes, heart attacks and cancers, and exercise helps to prevent all of these problems.
• If your hips or knees hurt, work with your doctor to find a cause.
• Try to move that painful joint every day. Inactivity causes further damage.
• People with cartilaginous damage to their knees and hips and those with hip and knee joint replacements should never run, jump, or walk fast. The impact of your foot hitting the ground causes further damage. Pedaling is done in a smooth rotary motion that does not jar the hip or knee replacements; however, a fall could be disastrous so consider a stationary bicycle or tricycles which Diana and I use. Jogging in water or swimming are usually safe as the buoyancy of the water dampens impact and helps to prevent joint damage.
• Delay hip and knee replacement surgery until it hurts so much that you can’t sleep at night or you have some other compelling reason.

John Forbes Kerry
December 11, 1943 – present