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Knee Replacement Considerations

  • When Knee Pain Hits the Tipping Point

  • Women are no strangers to knee pain. From adolescence into adulthood, we’re more likely than men to tear an ACL, experience chronic pain around the kneecap and, ultimately, suffer from degenerative arthritis in the knee. The irony is that we’re also more likely to live with pain far longer than we should.

    Recent research from the University of Delaware found that women tend to tough out osteoarthritis pain much longer than men before considering knee replacement surgery. And while physicians used to encourage people to wait on knee replacement as long as possible, new research and just plain common sense say otherwise.

    “Whether you’re 50 or 80, the most important thing for aging well is physical activity.” says internist Toni Brayer, M.D., chief medical officer of Sutter Health’s West Bay Region and lead medical advisor for MyLifeStages. “If you’re not able to be active because of pain in your joints, then you have to do something about that.”

    Brayer ought to know. As a life-long athlete, busy physician, mother,
    and all-around modern super woman, she admits that she was in denial about the state of her knee for a long time. “I just saw myself as this young, active person, so the fact that I was no longer active was a shock. When I finally recognized it, I went to an orthopedic surgeon and brought up the subject of knee replacement surgery.”

    Not long after that, she scheduled her surgery for the Christmas holiday. Now recovering from a total replacement of her right knee, she recently talked about her experience as a doctor, patient and woman.

    Toni Brayer
    What was the moment at which you knew you needed to have knee replacement surgery?

    I never considered that this was something I would be facing. I was in denial. I would try to hide it. I didn’t want anyone to see me limping, and I was surprised when people noticed that something was wrong. I had a lot of pain that I just pushed through. But one day I was getting ready for work and out of the blue, I just burst into tears and said, ‘I just can’t do this anymore. I am really crippled.’ That was my wake up call.

    You’ve always been an active person. Would you say you were “rough” on your knees?

    I’d never had a specific injury to my knees. As a kid and teenager, I was active in fast pitch softball and volleyball. As an adult, I’ve been a jogger, play a lot of tennis and ski in the winter.

    When did you begin to notice problems?

    About 10 years ago, I started getting pain and swelling in my knees with activity. At one point, I had arthroscopic surgery looking for tears. I was told that I had chondromalacia – irritation and eventual thinning of the cartilage.

    Did you change your activity level at that time?

    It was gradual. I used to do trail running, but had to switch to walking. Then I found that I couldn’t go up and down stairs. There was just a gradual decline in my ability to be as active as I would like.

    What sort of treatment did you have along the way?

    I did many things – physical therapy work like building up my quads, making sure I had good strength, icing after activity. I was eating Advil like candy. I also had one joint injection of a corticosteroid, which helped for a short period of time. Once I made the decision to have surgery, I did physical therapy pre-op to get as strong as I could before surgery.

    Toni Brayer
    How did you prepare logistically and emotionally?

    First of all, I knew what to expect. I had viewed the surgery. I also knew from both patients and friends that it was a painful, brutal, long recovery. It’s all true, and being prepared for that is really important.

    For me it was also a huge decision because of the time out of work. I had to really time it, which is why I chose the holidays. I hadn’t been away from work that long since having a baby. The average hospital stay is three to four days, but the home recovery takes much longer. It’s good to know that ahead and have supportive family. Get your ducks all lined up before you come home.

    So how has the recovery been?

    For the first few weeks, your life revolves around your knees. By the time you leave the hospital, you are walking with a walker or canes. You can safely go up and down stairs. The knee is very stiff and sore. At home, I spent my days either doing flexion/extension exercises or taking pain meds. (I got in a little bit of Oprah.) Sleep is disrupted, because of the pain.

    Toni Brayer
    How have you dealt with the pain?

    I’m a big believer in the liberal use of pain meds. If you get behind on pain, then you’re not able to do the exercises. It’s really important to do the strengthening and extension exercises, but you can only do that if you’re really well medicated.

    It’s been three months since your surgery, how do you feel now?

    They say it’s really a good year before your knee is where it’s going to be. I’m just now at the point, where I’m starting to enjoy the benefit of the surgery. My formerly “bad” knee is now my good knee! I haven’t played tennis yet, but I’m thinking of trying over the next month.

    We hear you even managed a volunteer trip to Haiti recently?

    Yes, the Haiti trip really catapulted my healing. I lost my bag and didn’t have my pain meds. I also didn’t have my good work shoes. It really stressed my knee, but I’ve felt great since returning. I think it pushed me into the next phase of recovery.

    What advice do you have for other women with knee pain who might be considering knee replacement?

    This is an end of the line decision and not something you do for an acute injury like a sprain or ACL tear. Those things are dealt with other ways. It’s really done because of osteoarthritis and the progressive diminishment of your ability to work your knee. If you are at that point, where you’re in a lot of pain with normal activity, pain going up and down stairs; you find yourself doing less and less because you don’t want to walk, then it’s time to start talking with your doctor about joint replacement. Thank heaven we have a way to correct it.

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