FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

THIS SURGERY OFTEN BETTER WHEN YOU "DOUBLE UP"

Question: My knees have hurt me for a long time. The surgeon told me that I should have both knees replaced, but that is a tough decision. Am I doing harm by waiting?

Answer: A decision to have surgery is always a stressful one involving many questions. Will I really be better afterwards? How severe will the pain be during recuperation? Will I be the one-in-one thousand that has complications? Can I afford it? I'm sure that your doctor has talked with you about these concerns with regard to your planned knee replacement surgery.

There are no universally accepted criteria to help you make your decision about knee replacement surgery. However, when surgeons are polled, several factors are consistently mentioned:

severe daily pain,

pain while at rest,

and evidence from X-rays that the joint space is obliterated by arthritic damage.

If all of these conditions are present in your situation, I would recommend you seriously think about having knee replacement surgery.

The knee is fairly simple in general concept: It works like a hinge. In practice, however, there are many subtle and important differences between a door hinge and our knees. The surgeon must take these variations into consideration in deciding which technical variant of "total knee" surgery to recommend. The doctor chooses a style of artificial joint and method of operating that is most likely to result in success for the individual.

Deciding when to have the surgery is largely a matter of selecting a convenient time for you and your family. In other words, delaying for a few months doesn't make a major difference in the outcome of the surgery, assuming that you continue to exercise to keep the leg muscles as fit as possible. Remember, though, that the sooner you have the surgery the more quickly you will be able to return to more normal activities.

A major concern of anyone having surgery is whether the procedure will actually work. Be reassured that knee replacement surgery is almost always highly successful. Several studies have confirmed that after two years virtually all individuals who've had this surgery report improved physical functioning, better social interaction, increased energy, decreased pain and improved emotions. Keep in mind that this doesn't mean that the knee will be pain free and work like it did when you were 18. It does mean that you can return to a better and more normal life without your knee ruling your activities.

Because many individuals have severe arthritis in both knees, it's often recommended that they be operated on at the same time. This "doubling up" approach may seem more intimidating, but it actually has a slightly lower risk of complications than having two operations on two different occasions. So, if you have problems with both knees, you should talk with your doctor about this option.

The average age of those undergoing knee replacement is over 70. Despite the other health risks of this older population, knee replacement surgery is relatively safe. The risk of death or life-threatening complications is about 0.5 percent for most hospitals, and almost all of these terrible complications are from heart attacks or other circulation problems.

Deciding whether or not to have knee replacement surgery is not easy. Talk about your concerns with your family doctor, your orthopedic surgeon and your family. They'll help you make the correct decision.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.