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Oh, my aching knee: At 45, a reporter undergoes replacement surgery
Link
http://www.usatoday.com/news/health/2007-09-09-knee-replacement_N.htm?csp=34
By Janet Kornblum, USA TODAY
I'd tried it all: Celebrex, ibuprofen, Darvocet, Percocet, Cortisone, Synvisc,
acupuncture, meditation, diet, glucosamine chondroitin, tears ...
And, oh, did I mention the six surgeries?
My right knee was, to use a technical term, kaput. But now, after surgery in
January, I'm the beneficiary of a total knee replacement.
A decade or so ago, most surgeons wouldn't have touched me with a 10-foot
scalpel. I'm 45. Though knee replacements for those under 50 are still
relatively unusual, I'm walking (thank goodness) proof that more surgeons are
operating on younger people.
The number of knee replacements has grown from 257,000 in 1998 to 455,000 in
2004, the last year statistics were available, according to the American Academy
of Orthopaedic Surgeons. And the mean age has steadily declined from 68.4 in
1998 to 67.2 in 2004.
That trend is expected to continue, thanks to the growing ranks of boomers -
many of whom "aren't going to accept a sedentary lifestyle," says Michael Ries,
chief of the University of California-San Francisco Arthroplasty (joint
replacement) Service - and my surgeon. "These are active people, and they're
unwilling to accept the restrictions that the previous generation had."
When Ries, 50, was trained, he was taught to "withhold joint replacement until
somebody was so old that they probably wouldn't outlive the prosthesis," he
says. "Now as an orthopedic community, I sense that our role has changed."
Still, doctors do try to avoid replacements at any age: They're painful and
risky, and even though techniques are improving, they generally don't last more
than 20 years. That means anyone under 60 could very well face a second
replacement; and each time, the surgery is more complicated because there's less
bone to work with.
Given all the risks and difficulty of the surgery and recovery, how do you know
when to go for a knee replacement? Unfortunately, there's no perfect litmus
test. Doctors can tell you how degenerated your bones are. They will give you a
list of options, if any are available. But ultimately, it's the patient's
decision. And often, it's a lifestyle choice.
Most say it's time when you absolutely can't stand the pain.
I thought I'd reached that point 10 years ago, but I was advised to wait because
of my age. I had bone-on-bone arthritis, largely the result of a surgery that
I'd had when I was 9 to remove my lateral meniscus, or cartilage, which was
irregular and slightly torn. Unfortunately, the standard treatment for damaged
cartilage before arthroscopy was removal, which caused trauma to my knee and
nerve damage.
But I "recovered" and continued to be an active child and young adult, running,
dancing and doing all sorts of sports. The years of wear and tear on a
cartilage-less knee slowly shredded holes in the layer of cartilage that covers
the ends of bones.
Some people start to have pain in their 50s or 60s and wake up one day at 60 or
70 to excruciating pain that gets worse. For some, severe obesity puts stress on
the joints. Others may have a previous injury - or just draw an unlucky genetic
card. Often it's a combination of factors that precipitate a knee replacement.
For me, the time came when I ran out of remedies that worked and activities I
could give up (over the years I'd given up running and dancing, boogie-boarding
and hiking) - and when the pain was so constant that it seemed as if my entire
life revolved around my knee.
On Jan. 23, a month after my 45th birthday, Ries sawed off my old joint and
installed a new one.
I had what is euphemistically called "minimally invasive" knee replacement
surgery; it is still pretty invasive. The incision is smaller and there is less
cutting into the soft tissues. But surgeons still saw off the ends of your
bones. Anyone considering this should understand that it's major surgery that
requires months of rehabilitation. (I was off work about four months.)
So, at seven months out, how is it? The truth is, I don't really know yet. I do
have full range of motion, thanks largely to a second hospitalization in which
my surgeon bent my knee under anesthesia to break up scar tissue. The agonizing
pain from arthritis is gone, but I still sometimes feel achy. I'm starting to
ride my bike and boogie-board, but the soft tissues on top of my knee still hurt
- sometimes a lot.
Some people have no pain within a few months. For others it can take a year -
even longer - to fully heal. And a few others face obstacles I don't even want
to think about.
I still want to hike, bike, boogie-board, swim and dance. And when I ask my
doctor if that can happen, he usually nods and says, "Sure."
I'll keep you posted.
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