FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

KNEE SURGERY AN OPTION FOR OLDER READER, IF OTHERWISE HEALTHY

Question: I’m 86 years old and in fairly good health except for degenerative joint disease in my left knee.  Cortisone shots don’t help.  After being on my feet for any length of time, my knee hurts, and I have to sit down for an hour or two with my leg up on the couch.  Are there any new procedures that could be done for this condition?  If they can do knee replacements successfully, why not joints?  Thank you very much for your advice.

Answer: I have some good news for you. The knee is a joint, and when a person has a “knee replacement,” it’s actually the knee joint that is replaced. Surgeons are also able to replace shoulder joints, finger joints, hip joints and ankle joints. The real question may be: “Are you a candidate for a knee joint replacement?”

Knee replacement is considered for patients who have knee joints that have been damaged or destroyed by trauma or a disease such as arthritis. Osteoarthritis, which is arthritis caused by wear on a joint, is the most common reason for knee joint replacement. The pain and loss of function that results from osteoarthritis leads many patients to consider knee replacement. The degenerative joint disease you mentioned is just another name for osteoarthritis.

Joint replacement is major surgery, but in most cases it is an entirely elective procedure. That means the surgery is scheduled in advance -- as opposed to an emergency surgery, like an appendectomy.

Due to this elective nature, you have time to carefully weigh the risks and the benefits before proceeding with the surgery. One of the things your doctor needs to consider -- and this is true of any surgical procedure -- is the ability of your system to withstand the rigors of anesthesia. While anesthesia is generally safe, people with weak hearts and poor lungs need to be carefully evaluated before undergoing surgery. Other risks of surgery are infection, bleeding, blood clots and nerve damage, to name a few.

Also, keep in mind that if both knees have severe damage, fixing only one will not give you much benefit. That’s why some people have double knee replacement operations or schedule a second one as soon as they are fully recovered from the first.

Another consideration is patient size. A person over 200 pounds may not get full benefit from the knee surgery. Some surgeons will not perform knee replacement surgery until the patient has reached an agreed upon weight. Also people who are very energetic may have trouble with the limited activity required during the prolonged rehabilitation period after the surgery.

Fortunately, the vast majority of those who have total knee replacement surgery have the expected outcome. They have improved mobility and much less pain after the post-surgical recovery and rehab periods. This benefit typically lasts for 10 years or more. At that point the surgery may need to be repeated.

You will notice that when I mentioned possible factors that would weigh against this surgery, I did not mention your age. Many healthy, active people in their 80s have joint replacement surgery. It can help to keep them active and enjoying life for many years to come.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.