Choosing knee replacement surgery shouldn’t be a knee jerk reaction

Going through security for a recent flight, the TSA announced that everyone who couldn’t go through the body scanner because of implants should move to the right. And, it was startling how many grey-haired folks moved into that line and how quickly they all began talking about their knee replacement surgeries.

Wondering whether or not this was some sort of anomaly, I sat down with Dr. Doug Cipriano, who’s been an orthopedic surgeon here for 22 years.

“More people are having knee surgery,” he said. “It’s because the baby boomers are more active and require more pain relief. In the past people didn’t live into their 80s and now they do.”

It’s all about arthritis, you know. The American Academy of Orthopaedic Surgeons explains that there are three basic types of arthritis that may affect the knee joint.

“Osteoarthritis is the most common form of knee arthritis. OA is usually a slowly progressive degenerative disease in which the joint cartilage gradually wears away. It most often affects middle-aged and older people.

“Rheumatoid arthritis is an inflammatory type of arthritis that can destroy the joint cartilage. RA can occur at any age. RA generally affects both knees.

“Post-traumatic arthritis can develop after an injury to the knee. This type of arthritis is similar to osteoarthritis and may develop years after a fracture, ligament injury or meniscus tear.”

Cipriano said that a patient should carefully evaluate the pros and cons of having surgery. Knee replacement surgery is major surgery and the recovery time, and the effort a patient needs to put into rehabilitation is considerable.

“The optimal time for surgery is when two things coalesce. One is that the objective findings, such as x-rays and MRIs, indicate that surgery is warranted, and two is that the patient’s symptoms negatively affect lifestyle. Not everyone should have surgery,” Cipriano said.

“Age is not a factor, per se. It’s a patient’s physiologic age not chronologic age. A healthy, active 80-year-old may be a good candidate, an unhealthy 60-year-old wouldn’t be. Someone very young would be encouraged to baby it along as much as possible because the long-term outcomes are unpredictable.”

The AAOS says that before considering surgery, you might want to exhaust the other treatment options for arthritis such as losing weight, changing from impact sports such as those that involve running and jumping to non-impact sports like swimming or cycling.

Strengthening leg muscles can increase flexibility and range of motion. Wearing a brace while working out or applying ice, heat or liniment afterward may help. And, of course, there are a multitude of drugs used to treat arthritis.

Your orthopedic surgeon can best advise you on those but they would likely include anti-inflammatory medications, supplements like glucosamine and chondroitin, or injections of corticosteroids or hyaluronate therapy which is a series of injections designed to change the character of the joint fluid.

So, all else failing, you decide to have replacement surgery. There are things you will need to commit to before and after the surgery in order to have the best results. Start with a complete check up by your primary healthcare provider.

“This is a team sport, not a magic wand,” Cipriano said. “Before surgery the patient should stop smoking; lose weight, if necessary; be nutritionally fit; optimize strength and motion; not have any dental issues, and have medical issues like diabetes and heart disease under control.”

Post-op the patient can expect limited mobility. Physical therapy will start right away. The basic functionality of everyday living will return in about six weeks. That’s when you’ll be able to drive again as it may take that long to recover reaction time, be off the narcotic drugs and off the walker.

You should regain full range of motion in six months to a year, but bear in mind that there will be activities that you’ll never be encouraged to do again. Golf, walking, cycling and kayaking will be fine, but you’ll probably have to say goodbye to long-distance running, skiing, high jump and pole vaulting.

Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at 264-4029 or kathyleehubbard@yahoo.com.