new needs, new knees

Medical technology is adapting to meet the needs of active baby boomers_especially women_who are having knee replacement surgery at a younger age

February 16, 2007|By Susan Thornton Hobby | Susan Thornton Hobby,Special to the Sun

Marlene Freed knows what's coming. For 10 relaxing minutes, she has been lying on her back, with ice chilling the swollen tissue around a seven-inch scar on her right leg -- the spot where doctors inserted her new titanium knee.

The 68-year-old Olney resident is laughing and chatting. But when physical therapist Chris Gnip climbs onto the table and starts to bend her knee, pushing it carefully but relentlessly toward her chest, Freed clams up.

She closes her eyes and starts to breathe deeply. Her hand clutches the plastic cushion on the office table. The more Gnip pushes that knee, the more the pain shows on Freed's face.

"OK," she mutters, and Gnip holds the knee in place.

"Five, four, three, two, one," he counts down. And finally lets go of the knee.

"So they know when the end is," he explains.

Freed has plenty of company in rehab these days. In 2003, the last year for which figures are available, doctors replaced more than 400,000 knees in the United States, two-thirds of them in women, according to the National Center for Health Statistics.

One reason for the continuing increase is that more active baby boomers are having knees replaced -- and doing it earlier than their predecessors. Women are also having more successful replacements than they used to -- and some credit a generation of new artificial knees designed just for them.

That happy knowledge does not necessarily make it easier for Freed, who had her left knee replaced in June and the right one replaced Jan. 9.

For an hour, Gnip puts her through her paces in the Clarksville offices of Physiotherapy Associates: leg raises, knee bends, quadriceps stretches.

"This is another fun one," Freed says, rolling her eyes and sliding her foot down the wall, bending the knee on her own while supporting it with her left foot. By this time she is breathing hard and is pink in the face.

"You're doing well," Gnip says.

Freed just chuckles. "You start out and you don't think it'll ever change," she says.

For Freed and others who wind up with replacement surgery, arthritis, injuries or the wear and tear of life have caused their knee cartilage to degenerate.

When the tissue that cushions the bones in the knee wears out, the upper and lower leg bones begin to grind together, causing pain and swelling.

When patients can no longer put up with the pain, and other treatments such as cortisone shots and arthroscopic surgery have failed, knee replacements are increasingly more popular options.

Freed decided to get the first one in May, when she traveled to Turkey and met two women her age who had already had double replacements. "Then," she said, "when I realized how much I could do with this new knee, I decided to get a matching one."

Among those 65 and older, the U.S. Centers for Disease Control and Prevention estimates that the rate of knee replacement increased eightfold between 1979 and 2002.

A 2006 study by the American Academy of Orthopaedic Surgeons predicts an astonishing 673 percent increase in the number of knee replacements during the next 23 years, with 3.5 million artificial knees implanted annually by the year 2030.

Obesity and a generation of baby boomers "wanting to stay more active" are the two main reasons for the most recent increase, explains Annie Hayashi, media relations manager for the surgeons' group.

Additionally, more people are getting their new knees earlier in life, says Dr. Kamala Littleton, the director of the Orthopedic Program for Women at Mercy Medical Center.

"We would wait, in effect putting Band-aids on the problem, until they were 65," Littleton said. "Surgeons were hesitant to perform surgery on younger people, trying to avoid more complicated revision surgery when the implants wore out.

"Now we're seeing 86 percent of knee implants still functioning well at 15 years. Essentially by waiting, we were making this person live a life of someone 20 years older. You don't want somebody who's 52 hobbling around, needing a cane, who can't play with their children or grandchildren, who can't enjoy activities such as golf or bowling or even just walking.

That's what happened to Marti Startt, 62, who tried arthroscopic surgery on her right knee to repair an old running injury that had developed into degenerative arthritis. It didn't help much.

"Stairs were hellacious," she said, forcing her to sell her third-floor walk-up and buy a condominium in a building with an elevator.

On Jan. 15, the Columbia resident had replacement surgery. Now she's working aggressively on rehab. "I just want to get back to normal life," she says.

The knee replacement operation, first performed in 1968, sounds as much like furniture repair as it does medicine.

The bits of bone and cartilage, damaged by injury or arthritis or both, are cut away. A shiny new metal saucer, shaped like the bottom of the femur, is spiked into the thighbone.

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