1 of 4
Phil Bencomo / Lake Superior Magazine
Joint Efforts: Getting Your Knees Back in Action
For a total knee replacement, surgeons replace the damaged bone and cartilage with a mechanical joint, shown here by Dr. Michael Pappas of St. Luke’s in Duluth. The operation has become popular with baby boomers suffering from knee pain.
2 of 4
Phil Bencomo / Lake Superior Magazine
Joint Efforts: Getting Your Knees Back in Action
Michael uses diagrams and models to explain the increasingly popular procedure.
3 of 4
Phil Bencomo / Lake Superior Magazine
Joint Efforts: Getting Your Knees Back in Action
More than 600,000 knee replacements are performed in the U.S. each year, along with more than 60,000 in Canada.
4 of 4
Phil Bencomo / Lake Superior Magazine
Joint Efforts: Getting Your Knees Back in Action
Lake Superior and the north woods inspire an active lifestyle. Here, we ski and skate, hike and run, paddle and surf, and we’re loath to slow down, even later in life.
Baby boomers, in fact, are once again changing the generational demographics. Unwilling to concede mobility to arthritic joints or injuries as they age, the boomers are receiving total knee replacements in unprecedented numbers and at younger ages.
According to the U.S. National Hospital Discharge Survey, the procedure is now the leading inpatient surgery for people age 45 and older. Between 2000 and 2010, the average age for knee-replacement patients dropped from 69 to 66 years old.
“The plan is to do their knee replacements to get back where they used to be,” says Dr. Michael Pappas, an orthopedic surgeon at St. Luke’s Hospital in Duluth. “And that’s one of the main reasons for these operations. No. 1 is pain, No. 2 is to get their function better.”
Advancements in the procedure are driving the boost and the Lake Superior region offers options to tap the latest techniques and equipment. The implants can be custom-made for each patient, and new hyperflex models offer greater bend without sacrificing stability. New plastics have nearly doubled, to 15 years, the expected lifespan of the replacement, while antibiotic cement and less invasive surgical methods have cut infection rates. All together, patients are pursuing the surgery earlier – and doing more with their new knees – than ever before.
If you think there’s a knee replacement in your future, Michael has some words of advice.
First, honestly assess your pain level: “I always tell patients, it has nothing to do with what the X-ray looks like. It’s how you are feeling. And the number one indicator for a total knee replacement is your pain level.”
Someone with a pain level of only 1 or 2, on a scale of 10, isn’t a good candidate for a knee replacement. “You’re always going to have a little bit of soreness. That will probably never go away, because it’s mechanical.” Patients with higher pain levels benefit much more.
Have you exhausted other treatment options? New Medicare rules require patients to try conservative measures first, including physical therapy and cortisone shots, before getting a total knee replacement. Those treatments buy more time to plan and prepare for what is no small operation. Losing weight can ease the burden on your knees, too, and building good exercise habits now will aid your post-surgery rehabilitation later.
Can you wait until 60 or even 65? People tend to slow down in their 60s, even in the outdoorsy north. For a replaced knee, that’s good news. Modern implants last longer than ever before, but they all wear out eventually. Delaying the surgery means extending the new knee’s life – and it could save you another operation later on.
If you go under the knife at 65 years old, you’ll likely need a single tune-up by age 80. But an implant at 55 years old would last until 65 or 70, and then in your 80s, you’d need a third operation to stay mobile.
Younger patients need to be prepared for that scenario, Michael says, but don’t let it deter you from pursuing the operation if nothing else works.
“There’s a breaking point. Can we get another year out of this with injections or with physical therapy, or is all of that stuff not working anymore and now the next step is a knee replacement? ... It’s a matter of how can you make this patient not hurt.”
There’s no hard upper limit, either. Michael has replaced hips and knees on hardy northerners in their 80s and 90s.
“It’s the good genetics up here,” he says. “We saw an 80-year-old lady, still (snowblowing) through 2 or 3 feet of snow. The only thing that’s hurting is her knees, so she gets a knee replacement, and she’s out doing everything she wants to do again.”
Once your doctor has determined that you’re a candidate for knee replacement, you need to prepare yourself, mentally and physically, for the rigors ahead.
“The first four weeks, you’ll wish you never did it because it hurts so much,” Michael explains. “The second four weeks, you’re glad you did it, but you don’t know if you’d do it again. Right between the 10- to 12-week mark, people are so happy with their knee replacements they’re ready to get the other side done.”
Plan the operation around your social calendar and the seasons: Most patients don’t feel right again until three months after the operation. If there’s a wedding on the calendar and you want to be ready for the dance floor, book the surgery well in advance. Also consider the time of year. Some people prefer to undergo the operation in the winter, to be back to full speed for our abbreviated Lake Superior summer. Others opt for the warmer months, when getting around during recovery is less hazardous – a tumble can knock your new knee out of alignment.
Set reasonable expectations: Three months after the operation, most patients feel great, but it could be up to a year before you’ve fully recovered. And remember, as with anything mechanical, the harder you push the knee, the faster it will wear out. Be reasonable.
Moreover, surgeons can only work with the bone that’s there. Patients with osteoporosis typically get fewer years out of their implants; the mechanical parts shift out of alignment more easily on soft bone, though it’s rarely a major problem.
Stick with the rehab: You do yourself no favors by skipping critical exercises. If you do, you’ll lose the mobility the new knee was supposed to provide.
“I could do as best as I’m going to do for my surgery,” Michael says, “but if they’re not motivated to do the therapy afterwards, they’re going to end up with a stiff knee, end up not doing well.”
But if you’re diligent, a knee replacement is truly life-changing. “It’s amazing,” Michael says. “And I’m happy to see when they come back and they’re up walking. It’s a big difference for them.”