Targeting Knee Pain: A Surgeon’s Outlook
By Dr. Riyaz H. Jinnah
I am an orthopaedic surgeon at Wake Forest Baptist Health, specializing in hip and knee replacement, resurfacing and reconstruction. Most of my patients are older or elderly and suffer from arthritis. Here’s what they tell me.
“I have a two-year-old grandson and I can’t keep up with him.”
“I want to get out in the garden, but my knees hurt too much.”
“I’m embarrassed to go to church with my cane.”
Osteoarthritis is a serious illness and by far the most common cause of disability in this country. As our population ages, the numbers grow. In lay terms, arthritis is the inflammation and deterioration of the cartilage that holds our joints together. When it strikes the knees, the pain can be crippling.
According to the Centers for Disease Control and Prevention (CDCP), more than half of all adults over the age of 75 will develop arthritis. And 25 million adults report that arthritis limits their activities one way or another. Some estimate that by 2020 more than 35 million patients – most of them older adults – will have had one or both knees replaced.
In North Carolina, more than 1.9 million adults have some form of arthritis. Many live with the condition, and some manage it with pain medicine, anti-inflammatory drugs and physical therapy. But the Centers for Disease Control and Prevention reports that 770,000 North Carolinians with arthritis limited their activity because of pain. That means they can’t play with their grandchildren the way they would like. Or they can’t get down to the river to fish. And because it restricts movement, the arthritis can lead to weight gain, so it’s not surprising that 73 percent of North Carolinians with arthritis are overweight. The extra weight, in turn, puts more strain on painful joints.
The problem is especially bad with knees. A recent study led by the Centers for Disease Control and Prevention found that nearly half of adults will suffer from painful osteoarthritis in the knees by the time they turn 85. The study followed 3,200 residents in rural Johnston County, near Raleigh, and found that the risk was highest for overweight patients. These patients had a two in three chance of developing arthritis in the knees. That’s why I lecture my patients all the time about losing weight and tell them: “For every pound you lose, your knee thinks you’ve lost three pounds.”
Thirty years ago, as people aged they became less active. But my patients are not happy to sit in their rockers on the front porch and wave as people go by. People have worked hard all their lives and they retire and they want to do stuff. And when pain stops them it takes away part of their life.
My colleagues in the Public Health Sciences Division at Wake Forest Baptist Health are studying the relationship between weight loss and knee pain in older adults. They’re tracking 450 overweight adults with osteoarthritis in their knees. I’m anxious to see the effect of weight loss on knee pain. In the meantime, the good news for thousands of patients in the region who suffer from knee pain is that we’ve developed surgical techniques that can help patients with osteoarthritis lead full lives without the pain and recovery involved in a full knee replacement.
The knee is a complicated joint, with three compartments, which means three areas where arthritis can take hold. In the early days of knee replacement surgery, doctors removed all the cartilage in all three compartments and replaced the tissue with metal plates. The surgery worked, but recovery from these total knee replacements was painful and could take as long as six months. In the 1990s surgeons started doing partial knee replacements, but the techniques were crude, and partial knee replacements often failed.
A lot of patients I see are reluctant to consider knee replacement surgery. They’ve heard stories about a long and painful recovery and they think they can carry on with the pain. Or they have friends who had a partial knee replacement some time ago, and it didn’t work. And they don’t want to risk a failure.
I came to Wake Forest Baptist Health from Oxford University, in England, where we had developed a precise technique for partial knee replacement, known as the Oxford Knee. What Oxford taught us is if you do it right, then it works. Now we have even better, more accurate, techniques.
My colleagues and I at Wake Forest Baptist use computer-aided robotic technology developed by a Florida company called MAKO Surgical. Before surgery begins, I start with a CT scan of the knee, and use the MAKO robot to make a map of the damaged regions. I still perform the surgery, with the robot as my guide. If I stray away from the mapped-out region when I’m cutting away damaged cartilage, the MAKO robot intervenes and stops my burr saw. This kind of precision makes today’s partial knee replacement much more effective. So far our team has used MAKO technology in 500 operations. Our patients typically spend a day in the hospital and recover in a matter of weeks -- not months.
Let me end with a story about a 97-year-old patient. His 75-year-old daughter brought him in to see me. He had been told he needed a total knee replacement. But he didn’t want to face such a major operation. He wasn’t looking for a perfect knee or the gait of a young man. He just wanted to be able to get around and stay at home. We performed a partial knee replacement and he’s one of my happiest patients. He can walk with a cane. He can go to church. He can get up in the middle of the night. And he’s still living in his own home.
I still preach prevention, weight loss and exercise. But the numbers tell us that if we live long enough, eventually arthritis will catch up with us. And that’s why I’m here.