Still, researchers at the Center for Hip and Knee Surgery at St. Francis Hospital in Mooresville, Ind., report that total knee replacement patients demonstrated "remarkable" use of their knees 20 years after the surgery. The findings were presented last month at the annual convention of the AAOS.
"There is no free lunch," says Baumgaertner. "When it is successful, it is a powerful change in your life, but when it goes bad, it can be catastrophic." Any lower extremity surgery, he adds, "can lead to blood clots, and infections occur in about 2 percent [of cases]." The patients' symptoms, he says, "should be severe enough that they are willing to accept these risks. I find that patients tend to be very good at deciding when they've reached that point."
Most orthopedic surgeons recommend knee replacements only after all other options have been explored. These options include rest, pain medication, cortisone shots, physical therapy, weight loss and arthroscopic surgery. And some, mostly younger patients, may see good results with an osteotomy, surgery that shifts the alignment of the knees so that the weight-bearing part of the knee is moved away from diseased cartilage and onto healthier tissue.
Lloyd Emanuel knew he had reached the point where he needed a replacement when even standing became painful. He's glad he finally had the surgery. "I don't know if I'll get back to 100 percent on the court, but I do know my quality of life is back 100 percent. There is no throbbing pain, I can sleep and I can play and teach tennis. And I am getting better every day."
Eight Key Facts About Knee Replacement
1. What it is. Surgery to replace weight-bearing surfaces of a knee joint. The surgeon cuts away damaged bone, cartilage and one ligament, and replaces them with an artificial joint made of an alloy of cobalt, chrome or titanium, and a plastic compound called polyethylene. A total knee replacement replaces the entire joint; a partial knee replacement replaces only the damaged area. While a partial replacement can be done with minimally invasive surgery and has a speedier recovery time, only about 6 to 10 percent of patients are suitable candidates for this operation. Partial knee replacements work best where damage to the knees is only in a small area [see "What to Expect After Surgery"].
2. Why have it. To improve mobility and decrease pain caused by degenerative arthritis or injury to the knee joint. "I liken it to replacing a car tire when the treads wear out and getting a wheel realignment," says Yale's Baumgaertner.