Joint Replacement of the Hip and Knee
To Do or Not to Do
Connie Christofferson’s knee problems began with a skiing accident when she was in her early 20s. The longtime Colorado Springs resident, now 61, tore her meniscus, a c-shaped cartilage that cushions the knee joint. Christofferson chose not to have surgery at that point, and worked hard on strengthening her quads to protect her knees. “I finally had meniscus surgery in 2000,” she says, “then ACL (anterior cruciate ligament) surgery in 2001. Things were better for a while until I started experiencing instability during my workouts. I went to my chiropractor for laser treatments and had a few cortisone injections from orthopedic doctors to defer surgery. After getting opinions from several doctors—all the x-rays and MRIs showed bone on bone—total knee replacements were suggested.”
For Connie, as for anyone experiencing pain and restricted movement due to joint damage, disease, or degeneration, total knee replacement was a big decision.
Eric Jepson, Orthopedic Surgeon with Colorado Springs Orthopedic Group, says, “There are numerous modalities which we try prior to knee or hip replacement. As a matter of fact, we encourage patients to keep surgical intervention as a last resort when it comes to arthritic joints. Things that we often recommend include use of simple over-the-counter medications such as Tylenol and ibuprofen or Aleve if the patient tolerates these, cortisone injections, gel injections which are advertised widely these days, physical therapy, use of braces and assistive walking devices such as canes, walking sticks or even walkers.”
Connie’s meniscus tear, it turns out, is fairly common in the sports world.
“Injuries of the lower extremities, especially the knee and hip, are common sites of sport injuries,” says David Walden, M.D. with Premier Orthopedics, who also served for many years as U.S. Olympic Training Center physician and as staff member with the Colorado Rockies and Colorado Springs Sky Sox.
“Recent changes in sports participation have led to an increase in many conditions,” say Walden. “Year-round single sport participation has led to many overuse problems. A large increase in female sports participants have led to an increase in acute knee injuries, especially tears of the ACL. Many athletes continue to participate into later life, which can also lead to conditions such as arthritis.
“As a sports medicine physician, our first goal is to prevent injuries. Overuse injuries can often be avoided by cross training, and acute injuries to the ACL can be decreased by training programs which emphasize proper jumping and landing techniques.
Warm-up routines have also changed to include active stretches such as moving lunges, and coordination exercises such as running through cones or stepping in and out of a ladder pattern.”
One of the newer techniques that shows promise in treating joint injury, says Walden, is a derivative concentrate of platelets obtained from the patient’s own blood, called PRP, or platelet-rich plasma. “This can be injected into a site of injury and stimulate a healing response… Stem cell injections may eventually prove to be the best treatment of all, but they are currently considered experimental and are not covered by insurance. Their cost makes them prohibitive for most patients.”
Arthroscopy, says Dr. Walden, was originally reserved only for the knee, but “improvements in technology, instrumentation, and technique have allowed a safe utilization in most joints, including the hip.”
The most common reason patients go on to total knee or total hip replacement, says Dr. Jepson, is degenerative arthritis of the joints. “This is normal wear and tear of the joints that leads to pain and disability. Other common reasons patients may develop arthritic changes in their joints include trauma, underlying autoimmune diseases such as rheumatoid arthritis or lupus, previous sports injuries or even congenital abnormalities and deformities that may have been present since birth.”
Despite Connie’s best efforts over a long stretch of time, it looked like her options had narrowed and she would join the ranks of the one million Americans undergoing hip or knee joint replacement each year.
Once the decision has been made, what can a patient expect?
“We’ve made huge improvements in total joint replacement in the past 10 years,” says Dr. Jepson. These improvements include the pain management we provide around the time of surgery. This has allowed us to decrease the use of pain medications dramatically, and has enhanced patients’ mobility after surgery almost immediately… We are able to do surgeries through much smaller incisions and be much less invasive regarding the soft tissues.”
Jepson says surgical materials have improved significantly, with implants expected to last much longer than in the past. A typical hip replacement surgery, for example, may take no more than 1-2 hours, followed by a 1- to 2-day stay in the hospital, or possibly even outpatient. “We typically get patients up on the day of surgery to begin walking with assistive devices… By 6-12 weeks we anticipate the patient resuming normal activities and even exercise or hobbies… Our desire in doing these surgeries is to have the patient’s quality of life improved without concern of having to go back to surgery some day.”
Dr. Walden says, “Doctors are experimenting with computer-guided cutting of the bone and positioning of the artificial joint – 3D navigation systems. Others are seeing whether or not robotic cutting of the bone and custom implants will improve results. All these advances need to be weighed against the increasing cost. One thing is for certain – tomorrow’s athletes will have better options and prolonged sports careers.”
Connie Christofferson underwent double knee replacement surgery in 2014 – the first replacement in November and the second just a month later. She began a physical therapy program right after surgery, working to strengthen her leg muscles and increase range of motion.
“I’ve always been an active person and had gotten to the point where it hurt to go hiking and do my workouts,” she says. “After the surgeries, I can hike again and I can hike longer without pain. I don’t have full range of motion, but it’s much better than before. Both knees are much more stable now.”