NEW KNEES/OLD KNEES?
My group of retired teachers stood to leave our spring get-together at Mitzi’s. Mitzi sat, planted in a chair, leg propped. Awaiting knee replacement surgery, she grimaced in pain, but called out gamely, “We’ll have our usual teacher’s retreat at my cabin but I’ll sit. You guys do all the work.” In 2008, my family’s Green Valley Lake cabin burned to the ground but teachers continued August gatherings, crowding into Mitzi’s cabin.
Next day Mitzi emailed, “SORRY!!! Mountain trip’s off. Can’t manage stairs up to the cabin.”
Exiting my Saturday class, I fell into step with a lady who complimented me on a recent column, then said, “I won’t be here next week, having a knee replacement.”
Running too fast to keep up with speedy Evie, a guy on a bike, pedaled up, “I’ve been watching you,” he said, “You’re limping. Are you thinking about a knee replacement?” He told me his doctor’s name.
Yowzers, is “knee replacement” the new appendectomy?
I count half dozen friends who’ve done one, or two, and no, none are runners.
Should I join the crowd?
Yep, it’s a “crowd.” Bostonglobe.com’s Courtney Humphries, 2012, “Do you really need a knee replacement?” says “…knee replacement surgeries are skyrocketing…attributed to many factors: growing rates of obesity, an active population of baby boomers now facing osteoarthritis, and the continuing improvement of artificial joints.”
Dorothy Feltz-Gray at arthritis.org writes that, “People younger than 65 are the fastest-growing age group opting for total knee replacement. Overall demand for the procedure is rising as well, with numbers expected to increase.”
Both authors caution us to think long and hard before signing-up. How to decide? Here are just three considerations.
LOOK AT YOUR AGE
Gretchen Reynolds of NY Times well.blogs, 11/13/14, in “Think Twice Before Choosing Knee Replacement, cautions the youngsters, 45-65 for whom knee replacement surgery “soared by 205% between 2000 and 2012.” Among 65 and older, the increase was only 95 percent, yet, surgical replacements were better suited for the older group because implanted materials wear out after a couple of decades—possibly necessitating a second surgery for the 45-65’ers.
Furthermore, older people who had “really bad knees,” benefited substantially from knee replacement surgery, gaining 20 points on a scale of improved knee function, while those with slight arthritis reported more pain and physical impairment, gaining only 2 points.
LOOK AT YOUR LIFESTYLE
What is meant by really bad knees? Reynolds quotes, Dr. Daniel Riddle, Virginia Commonwealth professor and study author who says, “If you do not have bone-on-bone arthritis, in which all of the cushioning cartilage in the knee is gone, think about consulting a physical therapist about exercise programs that could strengthen the joint, reducing pain and disability, losing weight helps, too,” Riddle says.
By “no cartilage” in Riddle’s definition I may qualify. In 2007, an orthopedist glanced at my knee X-rays, and said, “You have no cartilage in your knees.” “End of running,” I thought. “Reading my mind, the doctor, said, “Lots of runners have no cartilage, keep running.” I went on to complete six marathons.
So, “bone on bone” doesn't necessarily mean “really bad knees.” The deciding factor is daily serious pain. I don’t have knee pain unless I run too fast. No knee problem at my new slow rate: 12 to14-minute-miles. At the gym, I’ve given up weight machines which pain my knees, in favor of exercises learned at former physical therapy sessions. In short, I’ve altered lifestyle.
Globe’s Humphries offers the concept of “decision aid” to patients considering knee replacement. She quotes James Jacobsen who, like me is in early 70’s and had a “bone on bone” X-ray. His doctor recommended replacement, but handed him a pro/con video and brochure. He studied the materials: “I know right now that I’m not going to have a knee replaced until it’s absolutely necessary. If I didn’t have the [video and brochure] I wouldn’t [have known] how to make a decision.”
I’m not considering knee replacement. With lifestyle changes, my knee does not hurt with daily activities.
Mitzi, waiting in line for hers, says, “Dr. X did my left knee. I can’t wait for the right. If it goes like the last one, I’ll be pain-free for next year’s cocktails at the cabin.”