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Katherine Klopfenstein hadn’t gone grocery shopping for years. The 58-year-old Menomonee Falls resident began experiencing pain in her right knee in her early 50s, the debilitating effects of arthritis. “It was bone-on-bone,” she says of her damaged joint. “I couldn’t walk for more than five minutes.” While her husband took over supermarket duties, Klopfenstein embarked […]

Katherine Klopfenstein hadn’t gone grocery shopping for years. The 58-year-old Menomonee Falls resident began experiencing pain in her right knee in her early 50s, the debilitating effects of arthritis. “It was bone-on-bone,” she says of her damaged joint. “I couldn’t walk for more than five minutes.”

While her husband took over supermarket duties, Klopfenstein embarked on a frustrating roller coaster ride of pain and reprieve. Cortisone shots and other anti-inflammatory injections brought temporary relief, but the discomfort and disability always came back. She put on weight. Worst of all, she often couldn’t participate in activities that were important to her, like Christmas shopping for her family.

Then one day, the shots stopped providing any relief at all. After a series of X-rays, Klopfenstein consulted with her doctor, Timothy Morton, an orthopedic surgeon at Community Memorial Hospital. He recommended a knee replacement, and Klopfenstein decided to go for it.

She was in good company. More than half a million people undergo knee replacement surgery each year, a number the American Academy of Orthopaedic Surgeons predicts will continue to rise as more baby boomers find their joints wearing out. And more women have the surgery than men, accounting for roughly two-thirds of the procedures performed.

Despite their numerical edge, for years women were treated with knee implants designed for men. Now, new gender- specific knee implants – which Klopfenstein received – are made for a woman’s unique size and anatomical structure. Although many women have found good results with other implants, gender-specific versions offer surgeons one more option for ensuring a good fit and getting a patient back to her normal activities. Which, as anyone who has experienced debilitating pain will tell you, can’t happen fast enough.


Knee Epidemic
The vast majority of patients who have knee replacement surgery do so because of osteoarthritis, the gradual wearing away of the cartilage of the joint. “When you lose that cartilage, the underlying bone the cartilage is hooked to is exposed; now you’re walking on bone. And bone, unlike cartilage, has all kinds of nerves,” explains Dr. James Stiehl, an orthopedic surgeon with Columbia St. Mary’s Hospital and clinical associate professor at the Medical College of Wisconsin. The inflammation that results from the bones rubbing against each other can be a further cause of pain.

As human life expectancy grows, the cumulative wear and tear on people’s joints mounts. “People live longer, so they have a longer time that they’re on their knees,” notes Stiehl. Because women tend to live longer than men, more of them reach the point where they’re experiencing joint deterioration – thus, they have replacement surgery more often.

As baby boomers age, the medical community anticipates the call for knee replacements will continue to explode – as many as 3.2 million knees a year worldwide by 2020, Stiehl estimates. “The numbers are going up exponentially. It’s not a straight-line curve, it’s definitely a parabolic curve of increasing volume of cases.”

Not only are there more people reaching the age of knee replacement surgery than in the past, but as a group they have higher expectations for their physical health.

For women in particular, this is a generation that has enjoyed unprecedented levels of activity: Far more of them played sports or exercised than their mothers or grandmothers did. As a result, “more of them are showing up at a younger age for joint replacements,” Morton says.

The combination of more activity at a younger age and the desire to maintain that activity level for both women and men has caused the average age for joint replacement to skew younger, Morton says. Still, the range is wide. He puts the average at roughly 60 to 80 years of age.

Aside from injuries and general wear-and-tear, issues like obesity or work-related strain (such as heavy lifting) can also wreak havoc on knees over time, Stiehl notes.

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Women’s Knees
Although the circumstances that can lead men and women to develop osteoarthritis of the knee can be similar, the anatomy of their knees is different. Over the years, surgeons noticed some recurrent problems in using the standard implants for women. First of all, the female knee tends to be broader front to back – more square-shaped – than a male’s knee. “Because of this greater front-to-back dimension, you tend to use a bigger implant, and the implant then wants to hang out over the side, because it’s too wide,” Stiehl explains. Patients either have to tolerate this wideness, which can lead to soft-tissue pain, or the surgeon can use a smaller implant – “but then you have trouble balancing your ligaments because you used an implant that’s a little too small.”

In addition to addressing this sizing problem, the gender-specific knee implants also accommodate the unique angle and positioning of a woman’s knee cap.

Overall, the advance offers surgeons more ways to accommodate people’s anatomical vagaries, says Stiehl, who notes that some men are better fit with the female implant. “When we started doing these [replacement surgeries] back in the ’70s, they gave us two sizes, basically large and small. And right fit left and left fit right.” Now, seven standard and seven gender-specific sizes for left and right means “you’re up to 28 sizes for any patient that walks through the door.”

Although it’s not going to make a huge difference in every case and not all surgeons use it, Stiehl says the gender-specific implant can be especially helpful when it comes to sizing problems. “It makes a significant difference if you’re one of those patients who gets that soft tissue pain. And we know that females get more of that than males.”

The gender-specific implant is still new, yet experts are optimistic about its potential. “Time will tell, because the device has only been out for a short period of time, and in orthopedics, the proof is in our long-term results,” says Morton. “But it would make sense to me that if you can better match the way people are anatomically made with the mechanical device you’re putting in, you stand a greater likelihood they’re going to get a better result.”


What To Expect
During knee replacement surgery, the surgeon resurfaces the deteriorated or damaged ends of the bone, then caps the end of the bone with a metal and plastic component that takes the place of the previous joint. “[The device] realigns the joint to make it mechanically sound again … but it still relies on all of the patient’s own supporting structures, in terms of the muscles and ligaments, which are the stabilizers of the knee,” Morton explains.

In terms of recovery, patients can expect to stay in the hospital for two to four days. Also, they’ll likely use a walking aid, such as a cane, crutches or a walker, for four to six weeks. By three months, Morton says, patients are typically back to their regular activities. By a year, they will have regained as much motion and strength as they are going to achieve in the treated knee. Physical therapy usually begins during a patient’s hospital stay and is maintained through a home exercise program.

Once the treatment is complete, replacements generally last a long time. Based on his experience, Stiehl estimates that 95 percent of knee replacements will last 15 years; 80 to 85 percent will last 25 years; and about 60 to 70 percent will last 30 years. Repeat surgeries may be necessary once the device wears out.

Among other considerations, patients thinking about knee replacement surgery should find an experienced doctor, says Stiehl. “Surgeons who do more than 50 [knee replacements] a year have statistically better outcomes than surgeons who do under 50 a year,” he notes. Likewise, one recent study shows hospitals that perform more than 250 cases a year have significantly better results. Stiehl encourages patients to take an active role in their care, asking questions about caseloads, doing research, and talking to friends who have had joint replacements about their experiences.

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The use of computer tracking systems to perform knee replacement surgeries is another development patients may want to consider. Stiehl, who says he handles about 200 cases a year, uses the technology and believes it will soon become the norm due to its extreme accuracy and precision. “If you get that alignment off five degrees, that knee’s going to fail fast,” he says.

Six months after her surgery, Katherine Klopfenstein couldn’t be more pleased with the results. “I’m pain free for the first time in years,” she says. “I didn’t have any complications, and I feel just great now.”

On the day of our conversation, she’s preparing for a Caribbean cruise – where shopping, formerly an impossibility, will be a major item on the agenda. “I’m looking forward to hitting the jewelry stores,” she says with a laugh.

“Do you want me to have a pina colada for you?”


Caroline Goyette, a former assistant editor for Milwaukee Magazine, is now a New Orleans-based freelancer.

 


Health Tips 
Cutting down on binge eating. The American Journal of Psychiatry reports a study showing that sibutramine (Meridia) reduces the frequency of binge eating episodes. About 300 patients were prescribed a placebo or 15 mg of sibutramine per day. Those taking the drug cut their binge eating episodes from an average of 3.3 per week to 0.6 per week, while placebo takers typically dropped from 3.4 to 1.3 per week. On average, those taking sibutramine lost about 9.5 pounds, versus about 1 pound on placebo, over the 24-week study.


Go digital for younger, dense breasts. Digital mammography was more effective than traditional film mammography for women under age 50 with dense breasts, notes a report in Radiology.The study’s authors analyzed data from nearly 43,000 women who underwent both film and digital mammography for breast cancer screening. It’s not known why digital mammography performed better. The study also suggested film mammography was better for women over age 65 with fatty breasts, although results fell short of being statistically significant. The authors conclude that, for most women, either digital or film mammography is suitable.


Potent combo for prostate. For men with an enlarged prostate, a combination of drugs may work better than either used alone, according to a report in The Journal of Urology.The drugs – dutasteride (e.g., Avodart, Dutagen) and tamsulosin (Flomax) – treat urinary tract symptoms, such as acute urinary retention. And men interested in chemoprevention for prostate cancer (rather than surgery) may benefit from either dutasteride alone or the combination therapy. Prostate specific antigen, or PSA, is a commonly used indicator of prostate health. In the study, both dutasteride and the combo treatment lowered serum PSA by about 55 percent, while tamsulosin alone increased PSA by 12.1 percent.


Exercise helps chronic pain. Short-term modest exercise improved the physical conditioning and mood of chronic pain patients, according to a new study. Patients with chronic pain who exercised five hours per week for three weeks experienced short- and long-term benefits, according to a study presented at the American Academy of Pain Medicine’s 24th Annual Meeting.


Take two for joint relief. Two drugs that treat rheumatoid arthritis may be prescribed individually, but combining them may provide additional relief. RA patients with moderate disease activity taking either methotrexate (Rheumatrex, Trexall) or etanercept (Enbrel) alone may benefit from taking both together, according to a report in the Annals of the Rheumatic Diseases.The study of 227 patients reaffirmed the safety of combination therapy while showing it increased remission rates.

– Scott R. Weinberger

 

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