Joint Effort

Improvements in knee replacement procedures mean faster recovery and better results.

by

In 2005, Gerald Osborne was a competitive water skier, winning top placement in regional categories for his skills on the water. Accomplishing these feats at 55 years old was already impressive, even more so considering the torn cartilage resulting from osteoarthritis in the knee.

“For 12 years, I put up with a lot of pain in my knee,” says Osborne. “When I skied, it was like somebody was stabbing a knife in me every time I went back and forth behind the boat.”

Osborne says he developed a high tolerance for the pain during ski sessions, but at bedtime, he could barely stand the pain, and he had to sleep with a pillow between his legs. “I called going to bed ‘going to chase the pillow,’” he says. “I couldn’t stand for anything to touch the inside of my leg.”

With encouragement from his wife, Osborne had his knee examined by an orthopedic surgeon in Memphis, who conducted a knee arthroscopy — a procedure that inserts a tiny camera, called an arthroscope, into the joint to diagnose the problem and repair ligaments.

Osborne returned to skiing after that, but he still had pain. In 2003, he decided he’d ask another doctor, Dr. Owen Tabor of OrthoSouth, for a second look. After a second arthroscopy Tabor told Osborne that he would need a partial knee replacement, or joint resurfacing, due to a hole in the cartilage causing bone-to-bone damage.

“But I didn’t want to do a knee replacement,” says Osborne. “I had some kind of problem in my head about having something taken out of my body and having something metal put in place of it. Just something about that I didn’t like. I figured with all of this technology coming out, somebody could find some way to make cartilage and put it in my knee. But most places I talked to said that they don’t do that for people my age.”

But when his knee locked up at a Father’s Day dinner, he knew he had to act on it. He consulted with a third doctor, who agreed that he would need a knee replacement, so Osborne went back to Tabor to schedule the surgery.

“Ski season was already on me,” says Osborne. “I just thought, you know what, I’m going to ski this season, because maybe I won’t get to ski anymore after this. I don’t know.”

Osborne had his surgery in September 2005, and for four weeks, he wasn’t able to put any weight on his knee. But with the help of an intensive rehabilitation program three days a week, supplemented by three separate days in the gym, Osborne was prepared to ski during the following season.

“I was kind of putting a lot more into it, I guess, than the average person was,” he says.

Osborne was back on the water in April, and at first, he was worried about putting more strain on his knee than he needed to.

“The first time you go out there to ski, you get it in your mind, have I done enough work to do this?” says Osborne. “There’s a lot of pressure on your body when you water ski. And it takes a lot of strength. But I go out and I pop right up, and that thought goes away. I start running through the course. And after about a couple of sessions of days of skiing, it went out of my mind, and I never think about it anymore.”

“A lot of these folks, when they get arthritis, they quit going to church, and they quit going to Tiger games, and they quit playing golf, and they quit working in the garden. So the upside is that they can get their life back.” — Dr. Owen Tabor

His new knee held him up through a Tennessee State Championship in his division, where he won tenth place in his region. Now, at 69 years old, Osborne says he’s still skiing and has great mobility in his knee, aside from some difficulty straightening and bending his knee all the way.

“That’s just because of some of the previous work,” says Osborne. “So there was some ground I was having to make up for not rehabbing it right.”

To prevent further damage to his knee, Osborne alternates skiing and going to the gym depending on the time of year, staying out of the gym during ski season, and going to the gym during winter months. “During ski season, I really don’t go to the gym because I get enough exercise [and vice versa],” he says. “I went to the gym yesterday, and I burned around 1,068 calories. There’s no way you can go out there and do what I do and not be in shape. I can burn almost 1,000 calories in one ski set.”

Osborne says that he hopes his story will encourage others with knee problems to bite the bullet and get a knee replacement.

“If anybody gets to a point where they need knee surgery, they need to get it done,” says Osborne. “Don’t be stupid like me and wait 12 years with that pain, because it’s ridiculous. Get it over with, get about your life, and take care of it when you get it done. Rehab it well, and stay active afterwards.”

Addressing Fears

Dr. Tabor understands that it’s natural for patients like Osborne to be hesitant about getting a knee replacement or joint resurfacing procedure, and he has advice for those who want to wait.

“I will generally tell people anything that you can do that allows you to have a good quality of life and not have surgery, you should do that,” he says.

Osborne advises patients not to fall into taking narcotic medications to deal with the pain and lists alternatives: taking over-the-counter painkillers like Advil and Aleve, wearing a brace, getting cortisone shots, getting acupuncture, and taking supplements.

“But most people who are starting to think about joint replacement surgery have tried all of that, and their joint pain is the biggest problem that they’ve got, and their quality of life is pretty bad,” says Tabor.

Potential Risks

Once patients feel they are ready for surgery, Tabor assures them that the risks are minimal.

“Every time in life, every time you do anything, there are some risks,” he says. “I tell my patients that there are certain risks they are taking driving home.”

Tabor says that the success rate within the first 10 years after surgery is around 90 percent and 80 percent after 20 years. “In general, the success rate means that 10 years down the road, more than 90 percent of people who have a knee replacement will be functioning well,” he says. “That trend tends to go as far in the future as we’re aware. So in 20 years, the failure rate is maybe about 1 percent per year.”

Risks can include:

  • Infection could affect 1 percent of patients.
  • The need for a blood transfusion due to blood loss during surgery could happen in 2-3 percent of patients.
  • Blood clots could happen to 1 percent of patients.

The good news is, according to Tabor, that there are protocols in place to deal with these issues, including procedures that can clean infected joints and medications that can lessen the risk of blood clots and blood loss.

Despite these nominal risks, Tabor knows when his patients are ready for surgery.

“When they come to the day of surgery, there’s a subset of them who are scared, and there’s the bigger subset of people who have been hurting for so long that they’re like, ‘I have been looking forward to today for weeks.’”

Recovery

After surgery, Tabor says recovery time can vary, but patients are usually ready to resume normal activities about a month into recovery.

“Everybody’s a little different,” he says. “But before you get back to normal life and normal work and social life patterns, it’s usually about a month. And then even after that, you’re kind of stiff and swollen for up to a year.”

Patients who have received total knee replacements are referred to physical therapy to keep the knee flexible. Tabor usually recommends that these patients attend physical therapy three to four times a week for four to eight weeks. Once patients are able to bend their knees and get around without a walker, Tabor says patients can easily stop therapy and pursue a self-directed home exercise program.

Partial knee replacements, however, don’t typically require a referral to physical therapy.

“Every once in a while, I’ll have to refer someone to physical therapy after a partial,” says Tabor. “But usually, I tell them to take it easy for a week to 10 days, and get on a stationary bike. And that’s usually more than enough for people with a partial knee replacement.”

Total Versus Partial Knee Replacements

Tabor says that the difference in ability after surgery depends on the kind of knee replacement procedure.

Patients who have worn their entire knee out may require a total knee replacement, which requires resurfacing the end of the shin bone, the end of the thigh bones, and underside of the kneecap, and the removal of some ligaments.

“If Gerald had needed a total knee replacement, he would not have been able to return to the level of waterskiing that he did before,” says Tabor. “The knees don’t bend as far as you need them to bend to do what he does. They bend well, but not like a normal knee.”

A partial knee replacement, however, which is what Osborne received, involves no removal of ligaments, allowing for more mobility.

“It will bend as far as your natural anatomy will allow you to bend,” says Tabor.

Preventive Measures

According to Tabor, patients can take steps to avoid the possibility of needing knee replacement surgery.

  • Maintain weight: “Keeping your weight to a reasonable number is a huge deal,” says Tabor. “Knee arthritis is a lot more common in people who are significantly overweight.”
  • Low-impact exercise: “Exercise is great for your knee joints,” says Tabor. However, exercise should be limited to low-impact physical activities, like swimming, yoga, and bicycling.

Benefits

Tabor says that the number-one benefit to getting knee replacement surgery is the ability to resume normal, daily activities.

“Once you get over it, your knee doesn’t hurt, at least not much, and you can get back to your normal quality of life,” he says. “You can walk without a limp, you can rise up out of a chair without grimacing, you can go up and down stairs, you can go to New Orleans with your family and walk around the French Quarter. A lot of these folks, when they get arthritis, they quit going to church, and they quit going to Tiger games, and they quit playing golf, and they quit working in the garden. So the upside is that they can get their life back.”