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May 5, 2011 – Vol. 5 • No. 7

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With more options today, surgery
not the only recourse

Alveta Haynes is living proof that osteoarthritis doesn’t trouble only the old.

Back in the early seventies, Haynes was in her teens, ripping and running on the courts until she seriously injured her left knee playing basketball. She needed an operation, but arthroscopic surgery, then in its infancy, was a far cry from what it is now.

Instead of repairing the cartilage between her thigh and lower leg bones, surgeons removed the entire meniscus, reducing the cushioning in the knee — a perfect scenario for osteoarthritis (OA). Haynes needed time to recover but eventually regained use of her knee without limitations.

Haynes said the surgery did not slow her down. “I lived with it,” she said. “You figure out how to manage.”

For her managing meant icing, over-the-counter pain killers and leg elevation. Though Haynes could ease the pain, she could not prevent the structural damage that worsened over time. By the time she turned 35, she said, “my X-ray looked like an X-ray of an 80-year-old.”

The medical term is valgus but most know it as being knock-kneed, a condition in which the leg bones are not aligned straight. She needed reconstructive knee surgery, but she reasoned that she would wait until it became a day surgery.

Nearly 20 years later, after chronic pain and constant swelling took its toll, she finally relented.

And not a moment too soon.

Dr. John Wright, an assistant professor at Harvard Medical School and an orthopedic surgeon at Brigham and Women’s Hospital, has helped patients overcome misperceptions about knee replacement surgery. He also understands the human proclivity of delaying the inevitable. But he also knows the consequences.

“Waiting because you’re afraid is not a good idea,” he explained. “If you wait too long the results will not be as good.”

Timing is everything and Wright has heard most of the excuses. Some might say they will have surgery once they retire. Others will say they’ll have the procedure when the pain disturbs their sleep.

“Ten years later they are no longer active because of pain and disability,” he said. “They are not going out of the house, to church, and engaging in normal activities because of the pain.”

Women have even more excuses for procrastination. “Women wait because they’re caregivers. They tend to put others before them,” he said. But that’s not a good idea, Wright stresses. Women tend to get OA earlier than men; they get it in middle age. They have had too many years of wear and tear by the time they seek care.

He understands the misperceptions. Years ago the results for knee surgery were not as good as desired, but, according to Wright, surgical techniques have markedly improved since then.

Wright readily admits that obesity is a contributing factor to OA, but he cautions that obesity does not preclude the surgery. Losing weight “is not necessary to fix the problem,” Wright said. “If someone’s knees are worn out, the time is then. If you come back later and you are bigger, you are a worse surgical problem.”

Wright is among the first to say that knee or hip replacement surgery is not the only recourse. Many things can be done before surgery is recommended. Exercise, muscle strengthening and physical therapy are a few. “Get going,” he recommended. “Patients return and admit they did get better with exercise.”

But when pain is severe and non-responsive to medications and physical therapy, surgery may be warranted, particularly when reduced function is involved. Loose pieces of cartilage or torn menisci can be repaired through arthroscopy, an out-patient minimally invasive surgery. Often joint surfaces can be smoothed out. When a joint is destroyed beyond repair, joint replacement using a prosthesis may be required.

Haynes was 52 years old when she had her second knee surgery. By all accounts, it went well.

She said she was the best patient a surgeon could have. “If they told me to do five repetitions, I did 10,” she said.

Her hard work paid off. Even today — four years after her surgery — she experiences very little pain. When she does, she knows the drill so well that she gets a jump start. “I take ibuprofen and ice my knee,” she says. “If I don’t, I know the pain will start.”

Haynes got much more from her surgery than relief from pain. “I had no idea of the cosmetic impact,” she said. “That’s huge.” Her knock-knee had caused a change in her posture, gait and appearance. She now marvels at her straight left leg.

Haynes, 56, continues to exercise. At her home gym, she uses the recumbent bike and treadmill, but tennis is her passion.

“I don’t push it as much as I used to,” she said, noting she might not run flat out to chase an errant ball. “I don’t do things as aggressively as I once did. I limit myself. But I’m not worried about it. I have a lot of life ahead of me.”

Comments on Be Healthy? Contact Karen Miller at kmiller@bannerpub.com