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Need New Knees? Read This First

New surgical procedure cuts recovery time for many

By Jim Miller

December 7, 2007

• Need New Knees? Read This First • Acupuncture and Knee Pain • Can Acupuncture Help Knee Pain? • Harvard Studies Knees & Hips

Nearly half a million Americans – including the growing number of exercise-loving boomers – have knee replacements each year. But what’s the best way to get them? Most people have the time-tested traditional surgery that requires a deep incision into tendons and muscle. However there are a growing number of people opting for the newer, less invasive method.

Here are the pros and cons of each procedure.

Traditional Replacement

Developed back in the 1960s, traditional knee replacement surgery is still considered by many knee surgeons to be the gold standard, with predictable and consistently good results.

In a traditional knee replacement, an 8-to-12-inch incision is made typically on the front of the knee, through part of the quadriceps muscle and tendons where the damaged portions of the tibia (shin bone), patella (kneecap) and femur (thigh bone) are removed and the new knee components (made of metal and plastic) are installed.

While the large incision provides good working room to install the new knee properly, it also causes more tissue trauma resulting in a longer and more painful recovery.

So what can you expect following a traditional knee replacement operation?

Most patients spend their first post-op day or two on heavy pain medication in a hospital bed. Once they’re out of bed, they need a walker or crutches to move around and they remain hospitalized for a week, on average. Then it’s two or three months of physical therapy, more pain medication and relying on a cane, before they’re ready to start dancing again.

Less Invasive Method

With minimally invasive surgery (MIS), surgeons make an incision only 3 to 5 inches long to remove the damaged joint and install the implant. Muscles are pulled aside rather than cut – which is the key – so there tends to be less pain, a faster recovery and a shorter hospital stay.

Most patients, after an MIS procedure, take steps the very next day using only a cane. They spend only two or three days in the hospital and are walking without any assistance in a few weeks.

The main drawback to this method however, is that the smaller cut (3 to 5 inches) offers less room to work, creating a greater risk of misaligning the knee, which can cause pain as well as wear and tear on the device.

It’s also important to know that the MIS technique is not for everyone. If you’re overweight, or you’ve already had a replacement or extensive knee surgery you’ll need the traditional procedure.

Points to Consider

Before you decide to have any type of knee replacement surgery, here are some points to consider:

• Is it really necessary? Surgery should be a last resort, if other treatments such as knee supports, exercise, weight loss and ultrasound fail.

• Look for experience: No matter which procedure you choose, look for an experienced, reputable orthopedic surgeon and a hospital that does a high volume of total knee replacements. The American Association of Orthopaedic Surgeons (www.aaos.org) offers a list of board-certified doctors to help you search in your area.

Also, because the MIS technique is relatively new, less than 20 percent of the nation’s 20,000 orthopedic surgeons do the procedure. To find them, check the artificial joint maker sites like www.depuyorthopaedics.com, www.zimmer.com (which recently developed a new Gender Knee for women only), www.biomet.com (which offers a unique partial knee system), www.stryker.com and www.smith-nephew.com/.

• Do some research: Lots of good information is available on www.orthoinfo.org, www.aahks.org and www.arthritis.org.

• Check your insurer: Typically, both types of surgery cost in excess of $20,000. Many health plans cover knee replacements and Medicare coverage varies from state to state.

Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” books.

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