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

DR. WOLF'S PATIENTS AGREE: DO KNEE SURGERY NOW, NOT LATER

Question: I've had knee problems for some years now. I had arthroscopic surgery on my right knee three years ago to repair a torn cartilage. That helped for a while, but now my orthopedic doctor is recommending I have a total knee replacement because of extensive arthritis. He was very helpful in explaining the surgery he proposes, but I'm still uncomfortable. Obviously, his view of total knee replacement surgery is biased -- he makes his living do them. What do you think of total knee surgery?

Answer: The knee is like most parts of the body in that it is hard to imagine the consequences of having that part no longer work properly -- until it happens to you, that is. Then you realize how important that weight-bearing joint between the tibia (lower leg bone) and femur (upper leg bone) really is.

Arthritic degeneration, such as you have, usually limits the normal movement of the knee. In addition to the decreased mobility of the joint, the arthritis also makes it hurt. Typically, these problems are mild at first but become progressively worse as the joint deteriorates. The initial treatment for this is aspirin -- or another medicine that fits into the category doctors call "non-steroidal anti-inflammatory drugs" (NSAIDs) -- and physical therapy. Many patients also try non-traditional treatments such as magnets, copper bracelets, chondroitin sulfate, glucosamine and similar "wonder cures." Obviously, none of these treatments provide a cure for arthritis, although all may provide some relief for some individuals. Knee pain or stiffness that interferes with work, play or rest may be caused by several different conditions, including arthritis. Some of these disorders are amenable to surgical remedies. Many problems of the knee's supporting ligaments or cartilage can be operated upon, as your's were, with arthroscopic techniques. This involves using a telescope-like device to look inside the knee while the surgeon simultaneously guides other operating instruments to actually perform the surgery.

Knee replacement surgery is much more involved than arthroscopic surgery. It entails removing the damaged surfaces of the tibia and femur, and in many situations, the under-surface of the kneecap as well. In other words, some or all of the bony knee surfaces. New artificial metal or plastic parts are then fitted into position. The supporting muscles and ligaments are left intact.

Total knee replacement surgery has been done for about 100 years, but the techniques and materials used today have made this a common and effective treatment for those who have seriously damaged joints. Don't misinterpret this, though. Total knee surgery is serious business. There are risks -- even life threatening ones -- to consider before consenting to the surgery. Hemorrhage, infection, blood clots and unsuccessful improvement in knee pain or stiffness are among these.

Fortunately, most individuals have the expected outcome from total knee replacement. They have improved mobility and much less pain after the anticipated period of post-surgical recovery. This benefit typically lasts for 10 years or more, after which time the surgery may need to be repeated because of wear on the artificial parts or loosening of the connections between them and the bones.

The best guide I can offer about whether you should consider total knee surgery is the amount of pain and disability you experience because of it. In terms of my own practice, my patients have delivered a unanimous verdict. Every one who has had this surgery has told me later that they wish they wouldn't have waited so long. Talk to your surgeon and your family. Ultimately, however, it is your knee, and therefore, your choice.

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. Past columns are available online at http://www.FamilyMedicineNews.org.