Total knee replacement surgery is often a last resort for those whose cartilage has worn down, but doctors caution surgery alone is not the sole solution. NBC's Dr. Nancy Snyderman reports.
By Linda Carroll and Jane Derenowski
As we get older, none of us seems to be immune to deteriorating and painful knees. And that includes NBC Nightly News anchor Brian Williams, who announced tonight that he will be taking leave to have knee surgery.
Williams took a helmet to knee hit while playing high school football and has been in pain ever since.
“It reversed my knee – they don’t recommend that,” he said. “I’ve been in pain for 35 years. I loved playing a team sport. I loved every minute of football. I’ve paid a very high price for what’s been confirmed to be the single worst New Jersey High School Catholic League football career in history.”
Williams joins a multitude of other Americans with bad knees opting for surgery. Over the past decade the rate of knee surgeries has risen dramatically from 378,000 in 2003 to an estimated 704,000 in 2012, according to a government report released in 2012. The report also finds that people are getting knee surgery at younger and younger ages.
Some are suffering from old injuries that never healed right. For others, it’s just a case of bad genes.
“The best way to know how your knees are going to do is to look at your parents and grandparents,” says Dr. Richard McGough, an associate professor in the department of orthopedic surgery at the University of Pittsburgh Medical Center. “You can’t change your genes but there are some things you can modify, like maintaining a healthy weight, remaining flexible and getting exercise.”
While the previous generation had to grin and bear it, boomers have a chance to get their knees fixed. And a lot of them are heading for the operating room.
Do those rising rates of surgery mean this generation has worse knees than the last? While some of the increase can be blamed on the rising rate of obesity, which puts joints under more pressure, the main reason, experts say, is that knee replacement surgery has been so successful.
Over the last decade or so, surgeons have honed techniques and device manufacturers have refined their joint replacements.
“We understand the biomechanics of the knee in a much more sophisticated fashion,” says Dr. G. David Nazarian, director of hip reconstruction at Penn Orthaepedics and a clinical assistant professor of orthopaedic surgery at the Perelman School of Medicine at the University of Pennsylvania. “We’ve been able to design knee replacements that replicate the natural function of the knee and feel more like a natural knee than earlier versions.”
Beyond that, Nazarian says, surgeons have developed less invasive techniques that allow for a quicker recovery.
“We’re making smaller incisions and because of that there is less muscle being cut,” he explains. “So you’re getting less physiologic trauma to the body. And patients get out of the hospital more quickly and back to an active lifestyle more quickly.”
In fact, patients with a single knee replacement and a non-labor-intensive job can be back at work in just a few weeks, Nazarian says. For those with more physically demanding work, it can take six weeks. Patients also undergo physical therapy and full recovery can take up to six months to a year.
If patients truly understood the payoff, in terms of pain relief, there might be even higher rates of knee replacement, says Dr. Bert J. Thomas, chief of the joint replacement service at the David Geffen School of Medicine at the University of California, Los Angeles.
In William’s case, the pain has gotten so bad that it is interfering with his sleep, he said, so he decided it was time for the surgery.
“I reached a point recently in the last 12 months where I decided this has to happen and to be mathematical about it, I've lived now most of my days so worst case scenario, if this doesn't go perfectly well, which it will, it can't hurt more than it hurts now,” Williams says.
Ultimately the pain is what drives many patients to have the surgery, but it’s not uncommon for them to wait as long as possible first, says Thomas.
“Some would rather put up with disability than choose what to them is a quite frightening option of surgery,” he explains. “Most of those who come in say, ‘Look, my knee hurts and it’s interfering with my activities. I’d like you to do what you can: pills, shots, therapy, whatever, so long as it’s not surgery.’”
Surgery gives many patients a much more active and pain free life, Thomas says. “It’s a wonderful operation,” he adds. “Some patients literally come in in a wheel chair and three to five days after their surgery they can be up and walking without pain.”
That rings true for Taryn Mason-Jones. She did everything she could to postpone surgery even though her doctors said she needed it to quiet the excruciating pain in her joints.
It took six years before Mason-Jones finally agreed to have her knees done at age 46. “I thought I would try to put it off until I was 50 or 60,” says the 56-year-old nurse from East Norriton, Pa. “But it became harder and harder to live. I had difficulty getting in and out of the car and trouble walking up and down stairs. I was always in pain. It would wake me up in the middle of the night.”
After the surgery, Mason-Jones was angry with herself for waiting so long. “I like to say I got my new life on June 1, 2004,” she says. “The pain I had was gone. It really was like getting a new life.”
Knee replacement sounds a lot worse than it is. In reality the knee itself isn’t replaced, just the joint’s deteriorated cartilage. So, instead of cartilage, patients end up with metal on one side of the joint and plastic on the other.
People start out with about 3/8 of an inch of cartilage between the bones – 3/16 on each joint surface – says Thomas.
“When patients come in they don’t even have a millimeter of cartilage left between their bones,” Thomas says. “In some cases it’s so bad that you have one bone grinding grooves into the other.”
While the new joints allow people to resume most of their activities, surgeons like Nazarian advise patients to stay away from sports like long distance running, fearing that the constant pounding will take years off the “life” of the replacements.
The good news, Nazarian says, is that studies have shown that replacement knees last a long time: 20 years on average, even for older models.
After fully recovering from surgery, patients can often do many of the things they’d had to give up, says Dr. Russell Windsor, attending orthopedic surgeon at the Hospital for Special Surgery in New York, N.Y.
“The only thing we really don't advocate is long distance, every day running, which is what a lot of people do do,” Windsor says. “But you can do low impact things all day long for example. You could bike. Do the elliptical treadmill. You can do everything and by that I mean, you could play doubles tennis. You could run within the context of the sport you play here and there for fun. And so in essence, overall, for all intents and purposes, when you do a knee replacement, the overall function gets back to as close as a normal lifestyle as you could get it.”
Brian Williams talks to Dr. Nancy Snyderman on Nightly News.