complications such as a buildup
of scar tissue and the withering
of the patient's bone may make
a second replacement more diffi-
cult, he said.
Dr. Goldman said that the de-
cision to undergo joint replace-
ment isn't one that should be
made lightly.
"As a physician, I feel it's my
moral obligation to be honest
with patients in letting them
know what works well and what
won't work," he says. "For ex-
ample, there's a high proportion
of failures in knee-replacement
surgery for patients who are
grossly overweight. If that de-
scribes one of my patients, I'll ask
that person for a commitment to
lose weight before I operate and
to lose more after I operate.
"And I'm not very interested
in operating on someone who
says he wants the replacement
so that he can downhill ski with
his grandchildren. It's very like-
ly that patient will fall while ski-
ing, tearing apart his knees
again. I'm more likely to operate
on patients who understand their
condition and want to get on with
their lives but recognize that they
won't be able to do everything."
Post-operative
therapy may help
with recovery.
Arthur Friedman of West
;= Bloomfield has taken up golf,
gone back to playing tennis and
sneaks in some aerobic activity
since both his knees were oper-
ated on five years ago. He's fair-
ly certain his surgeon at the
Cleveland Clinic wouldn't agree
with all of his activity, but he
does feel like a new person and
he is trying to moderate his
lifestyle — just a bit.
"My knee problems started
with an old football injury and
then probably deteriorated be-
cause I continued to abuse them,"
says Mr. Friedman, who used to
run 10 to 12 miles on a regular
basis and play tennis.
"I made up my mind and opt-
ed for surgery when I visited our
children in California," he said.
"We were taking a hike over this
small cliff as a way to get to the
ocean — except I could only walk
about 20 feet and had to stop.
They went on ahead of me. I sat
on the mountain and cried. I
came home and started looking
up information about knee re-
placements."
The knee joint is one of the
more complicated joints in the
body and one of the more unsta-
ble because it connects two bones
— the femur and tibia — that
don't directly mesh with one an-
other. These two bones are also
the two largest levers in the body.
A third bone, the patella, is not
attached but is suspended in
place by ligaments between the
femur and tibia.
The knee is a very powerful
joint, able to withstand tremen-
dous stress, sometimes up to four
or five times the weight of the
body. But the knee's complicat-
ed nature and ability to handle
great loads makes it more vul-
nerable to injury. Ligament tears
can affect the joint's fluid oper-
ation. Degenerative changes from
arthritis can eat away at the car-
tilage, resulting in pain and stiff-
ness.
Dr. Jeffrey Shapiro, an ortho-
pedic surgeon and team physi-
cian for the Detroit Pistons and
Detroit Vipers, said much of the
success of knee-replacement
surgery depends on the commit-
ment of patients during the re-
cuperation period.
"Traditionally, back in the
1960s and 1970s, surgeons ce-
mented prostheses in place," Dr.
Shapiro explained. "Many im-
plant failures occurred where the
cement met the bone because the
rubbing of bone against prosthe-
sis created particles of cement
that irritated tissue and eventu-
ally loosened the implant.
"Today there are different
methods and materials, such as
titanium, that are used in the
procedure that don't break down
as quickly and provide more op-
portunity for bone ingrowth."
And, the techniques and ma-
terials for knee-replacement con-
tinue to improve. For instance,
some implants contain pegs that
align and secure the prosthesis
in the bone. In cases of severe
deformity, where standard pros-
theses aren't suitable, a com-
puter-aided design system can
be used to create individually fit-
ted devices.
No matter what the technique
or the high-tech material, pa-
tients who return to their for-
mer level of physical activity run
the risk of loosening the pros-
thesis, wearing it out improper-
ly on its surface and even the
possibility of fracture and dislo-
cation. ❑
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