Knee Replacement Or Not?


What normally comes into your vision when you think of Knee Replacement? Do you think of receiving an injection of some magic fluid into your knee socket, so that hereafter you might spring around like a gazelle, playing tennis and golf and meeting all your fifty year old friends for lunch after 18 holes of “on the cutting edge competition? Or do you believe you might go into surgery in the morning, where they do a mighty work, creating something for your knee that will bend in the middle, so that you can get behind your walker and shuffle ahead with great dexterity? We, the public are somewhat protected from what really happens behind the closed doors of the surgical suite, but if one should decide to have the surgery, many informational doors swing open, hospitably, to reveal the truth. And the truth is that the replacement leg is actually cut through the femur at the top of the kneecap, and cut through the tibia at the lower end of the kneecap: the joint itself is replaced with a prosthesis, which is driven by pounding into each exposed bone at each end of the prosthesis, blood vessels and nerves are returned to their positions. The skin is stitched back together for a last step in the procedure. This is a grossly simplified picture, but it gives you an idea of what you cannot change once the cuts are made. This is a picture each person should have before committing to surgery of this kind in my opinion.

We cannot neglect, however, the fact that there is no cure for arthritis: the solution to the arthritis problem amounts to a control for arthritis, for example, pain medicine. At this point we still have the aging process to contend with and our own idiosyncrasies, like being obese, like being involved in sports that injure our knees, ankles and hips during our early and middle ages that encourage arthritis to settle there. We can, of course, agree to lose weight, which would help tremendously in relieving the pressure on our knees, but we all know what wimps we are in the field of weight loss. Maybe we could stop skiing at age 49, reckoning that middle age starts at 50, if we have not already hurt ourselves beyond measure, and avoid those crippling injuries that happen in middle age. It is like trying to tell the teenage football player that he has to give up football because he already has too many head injuries!

Nevertheless, if you are one who needs surgery badly because your knees hurt all the time and you are finding that too much ibuprofen, which is such a good pain-killer, blights your liver and you need relief from pain, there are some very good orthopedic surgeons in the United States who can treat your knees with prosthetics and minimal surgery. Or you can have the full-cut surgery. Minimal is just a smaller cut into the skin only large enough to accommodate the prosthesis. Full-cut is a larger incision that gives your doctor more room to manipulate the prosthesis, and this method will make the healing time a little longer. 

This is a very successful surgery and many people benefit from it. But do not forget that prostheses wear out and you may be looking for a replacement prosthesis in 5-10 years. If scientists continue to improve upon knee prostheses, they will last longer, so look for less need for replacement.



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