Transcription:
Knee Replacement Surgery: When is the Right Time

Melanie Cole (Host): How does someone know that they need to have their knee replaced? Is there a way to delay having knee surgery or other treatment options before surgery? My guest today is Dr. Matt Reckmeyer. He’s an orthopedic surgeon with Lincoln Orthopedic Center. Welcome to the show, Dr. Reckmeyer. Let’s talk about the knee. It’s such an important joint, such a base for so many things that we do. When does knee pain signal something more serious?

Dr. Matt Reckmeyer (Guest): Anytime you have knee pain there’s the potential for some significant problem going on, I should say. Pain is not a normal thing. Once you know why you’re having the pain, then it’s easier to decide what you need to do. The fact that knee pain is present would be a signal that there’s something wrong. We use that as our main guide to developing a treatment program.

Melanie: We all get a little knee pain here and there or maybe it’s the shoes that we’re wearing, something along those lines. When does it turn to the fact where you might possibly need a new knee?

Dr. Reckmeyer: Most of the time, you don’t need a knee replacement when you’re young, although we don’t hold people’s age against them is what I usually tell patients. You could be unlucky and develop knee arthritis in a premature fashion. Most of the time, you’re at least in your mid-fifties or later before you start to develop the kind of degenerative changes that lead us to a knee replacement. Some people have injury when they are younger and that can pre-dispose to earlier degenerative changes to occur but if you haven’t had any kind of an injury and you just start to develop pain in your knee as you age, that’s kind of a clue to us that there is a possibility that you might be looking at something in the order of a knee replacement.

Melanie: What about things that are your first line of defense? If someone comes to you and they have knee pain, do you do cortisone shots, bracing, icing or exercises? What do you do for them first?

Dr. Reckmeyer: Actually, all those things are on the list. What I usually tell people is that they have three basic categories of treatment. One is self-care which includes the over-the-counter anti-inflammatory medications which oftentimes people have already started. Use of a knee support brace is often times helpful; intermittent ice treatment. Sometimes the topicals like Icy Hot and other products of that nature can be quite helpful to help manage the pain. Of course, none of these things have an impact directly on the disease process itself. Really, the only thing that stops the degenerative change is the surgery but, at the same time, if we can manage the pain the process progresses slow enough that you can often times get several years of non-operative treatment before you actually have to have surgery. The second area that we oftentimes use would be the more limited injection type of treatments. Cortisone shots are the mainstay of the injections. There are some other products on the market now. FDA approved what we called visco injections which is originally a chicken comb product but its hyaluronic acid. It is a lubrication factor that can be helpful. There are some other things being tried that are not really main stream and they’re not approved. There are some stem cell things out there and that kind of stuff but there’s really no good medical evidence that those things are very much help at this point in time.

Melanie: If they’ve tried the hyaluronic acid or a cortisone shot, non-steroidal inflammatories, exercises to strengthen their quadriceps, hamstrings, calves--all of these things you’re recommending and none of them are working, what’s involved in knee replacement surgery?

Dr. Reckmeyer: The operation is a pretty standard procedure. There are several little variations but the general idea is basically a resurfacing operation that replaces the ends of the bone of the femur on the thigh, the tibia on the lower leg and the posterior, or the back side of the knee cap or the patella. That involves, typically, an incision in the front of the knee somewhere between four and five inches in length. The operation takes somewhere around an hour or so to do. You’re in the hospital usually at least overnight. Most patients are staying a two-night stay. There are some centers around the country that are promoting outpatient knee replacements. Most of those people are having partial knee replacements but, in the overall picture, most people do better if they have someone with some expertise keeping an eye on them overnight and a day or two of getting started on their rehab and then they can progress on from there.

Melanie: You mentioned partial knee replacement. What’s the difference between a partial knee replacement and a full knee replacement?

Dr. Reckmeyer: The knee is made up of two main condyles which we call “medial” and “lateral” condyles which are the weight-bearing part of the joint. Some patients will just develop more aggressive deterioration on one or the other and, if the other half still looks to be in pretty good shape, especially if you’re younger--at least that’s how we typically look at it is that a young patient might be a better candidate for a partial, anticipating that over time they might have to proceed to a total. A partial is just basically half the knee. You resurface the end of the thigh bone on the inside or the outside half and resurface the tibia on the lower leg. It’s a little less surgery. It doesn’t take a whole lot less time to do it because you have to balance what’s still there and you have to be a little bit more precise on the procedure but the overall recovery seems to go a little bit easier for the patients. They don’t have so much trauma to their joints and they can get up and get moving a little faster. It still takes several weeks for full recovery, though.

Melanie: Let’s speak about life after knee replacement. How fast can they get into physical therapy and get moving again and work range of motion and get that knee so that it really does what they want it to do?

Dr. Reckmeyer: Actually, we start the therapy the same day of the operation. The patients come out of the operating room, typically, say, with a morning operation, and they’ll have a session of physical therapy in the afternoon, starting with mainly just getting up and starting to weight bear and to walk. The range of motion is one of the more difficult things after knee surgery, so the therapist gets started on a little bit of bending and straightening exercises. We start that right away. Usually, by the end of a couple of weeks, people are walking around with their cane just for a little balance and support and, typically, in less than a month, you can walk pretty well through your normal daily activities.

Melanie: Then, afterwards, what do you recommend to people about exercise, sports, weekend warriors and how they should treat that new knee?

Dr. Reckmeyer: Really, the only real restriction is avoiding high impact with knee replacement. The parts are not the same as you own biology and so, we try to have people limit their impact by avoiding things such as jogging or jumping or things like that. I let my patients do pretty much anything else, including, certainly, hiking, swimming is an excellent activity, bicycling, playing golf or even tennis. All those types of things are on the “okay to do: list. We do have an occasional patient who likes to go out and do the 5K runs but if you’re more of a shuffle runner, then I guess that’s okay but anybody who likes to compete in more vigorous things such as basketball and jogging and that kind of thing, that’s really the only thing we try to restrict.

Melanie: Give us your best advice, Dr. Reckmeyer, for prevention--of possibly not needing a new knee. What do you tell people every day about keeping their knees healthy? It’s such an important joint.

Dr. Reckmeyer: Some of it you can’t really prevent. If you’re genetically pre-disposed, if grandma and grandpa both had their knees replaced and that kind of medical background or history is in your genetics, then it’s probably something you couldn’t necessarily avoid but if you live a pretty healthy lifestyle, maintain a healthy body weight, keep good strength in your legs, good nutrition – all play a role in maintaining healthy joints, in general. I don’t know that we have any good medical science to tell us there is any kind of super food that will prevent arthritis but if you’re reasonable with your joints and take good care of yourself overall, you’re probably doing the best that you can.

Melanie: Why should they come to Bryan Health for their care?

Dr. Reckmeyer: Bryan has had an excellent track record over theyears of good quality care. They’re on the cutting edge of the technology and I think they provide just a great environment for people to have their general healthcare overall in addition to their orthopedic surgical care.

Melanie: Thank you so much Dr. Reckmeyer for being with us today. You’re listening to Bryan Health Radio. For more information about knee and joint replacement surgery, you can go to bryanhealth.org. That’s bryanhealth.org. This is Melanie Cole. Thanks so much for listening.