When a Knee Replacement Specialist Needs His Own New Knee

Ira H. Kirschenbaum, MD

Disclosures

September 07, 2016

In This Article

Editor's Note: Ira H. Kirschenbaum, MD, chairman of the Department of Orthopedics at Bronx-Lebanon Hospital Center, Bronx, New York, has performed over 3500 total knee replacements. When Dr Kirschenbaum needed a new knee himself, he kept a diary from a perspective he had taken for granted that he understood: that of his patients.

Despite being an expert on the procedure he was about to undergo, much about the experience leading up to the surgery was unexpected, which Dr Kirschenbaum recorded in his diary. Part 1, presented here, offers his thoughts before and immediately after the procedure. Part 2, coming soon, includes his reflections on postoperative pain management.

My Knee Is Now Your Knee

August 17, 2016

I have always had a certain amount of knee pain, but at age 59, I am scheduled to have a left total knee replacement next Monday, 6 days from now. I am used to being the surgeon. This time I am someone else's patient.

Since venturing from my fellowship in joint replacement surgery at the Rothman Institute in Philadelphia in 1991, I have performed over 3500 knee replacements without a sense that one day this might be my fate too. Performing a knee replacement is a surgical religious experience. It is thoughtful, elegant surgery coupled with a massively positive intervention in the quality of life of the patient.

In good hands, a knee replacement takes about 45 minutes to an hour to perform. The results are so good that when a less-than-optimal result happens, we surgeons experience a great sadness for our patients because we feel that we do the operation the same way each time—and, as such, we expect consistently good results.

When the results are just not good, it's frustrating. Even if this only happens 3% of the time, all you have to do is crunch the numbers. If a surgeon does 200 knee replacements a year and 3% of patients are not happy with the result, that means that six people a year—a lot of people—are not pleased with the surgeon's attempt to make them feel better. This sometimes makes for a tough job.

Now that I am about to be at the other end of the scalpel, I have two fears. The smaller one is the pain after surgery. That will be temporary. Considering that my surgeon uses a multimodal approach to pain—with many medications and modalities, as well as the use of a long-acting local anesthetic—I think the pain will be manageable enough. We shall see.

The bigger concern is whether, despite the skill of my surgeon, I will be in that 3% of patients who have a less-than-optimal result. This is the group in which everything went well in the operating room, the x-rays looked great, and by all accounts their results should have been home runs, and yet they weren't. In my past 25 years in surgical practice, I have seen too many patients who were in that 3% to know that it is impossible to predict whether I will be one of them.

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