When a Knee Replacement Specialist Needs His Own New Knee

Ira H. Kirschenbaum, MD

Disclosures

September 07, 2016

In This Article

This Is Not Happening to Me!

August 17, 2016

It is really a strange moment of disbelief—that you will lose a part of your body. When this moment happens, you try to look back to see when it all started. Everyone can go really far back—to Pop Warner football or to a host of other relatively uneventful but memorable knee injuries. Unless you had a major trauma to your knee (which I never did), most knee arthritis—the most common disease that leads to knee replacement—is not easily explained, other than that somehow it was in your body's master plan for you. Whether this was somehow inherited in your family's genes or is unique just to you, we really don't know. The best you can say is that it is fairly common; over 1 million people each year need joint replacements in the United States alone.

It is really a strange moment of disbelief—that you will lose a part of your body.

I remember the last time I ran, though. It was in the fall of 2012. I thought about that time when it became clear that I was going for a knee replacement. My youngest son and I were coming home from a New York Knicks basketball game and had the chance to take the 10:36 PM train out of Grand Central Station if we moved fast enough. The consequence of missing the train was having to take the 11:05, and considering that the food court in Grand Central was closed by then, there was no intelligent reason to be waiting around. We had to start running.

Having run track in junior high school and played football in high school, running was simply running. No biggie. Bolting to the S train, the shuttle to Grand Central, I heard a pop in my knee, and it buckled with the simple clarity of PAIN! For the rest of the successful journey to catch the 10:36, I walked fast. No self-respecting New Yorker misses a train, even if it means hopping on one leg. I never ran again after that day.

Fast forward to September 2015. I was increasing my exercise regimen—nothing crazy, mind you: about a half hour of weights and the same amount of time doing cardio. I did a particularly vigorous quads set on a machine, and the next morning the pain in both knees was incredible. I fully expected that with a little rest, ice, Aleve® (naproxen), and time, I would be back to baseline. The right knee rapidly improved. The pain never stopped in the left knee, however, and a cascade of events had begun that caused the further demise of that joint. When I eventually got an x-ray and saw bone on bone, I have to admit that I sensed the left was doomed. I was not going to let this happen—a knee surgeon needing a knee replacement so young—so I embarked on an aggressive but conservative treatment journey.

Anything But Surgery!

August 17, 2016

Once you truly need a knee replacement, there really isn't a lot you can do to avoid it. The only people, in my experience, who can avoid a knee replacement by trying a particular exercise regimen or injection product don't really need a knee replacement in the first place. Once the bone on one side of the joint touches the bone on the other side and you begin that terrible painful slide down into arthritis pain, it is unlikely that you can avoid surgery. You can definitely do some maneuvers to temporarily relieve the pain, and as long as you continue to do these things, you can postpone the inevitable for a few months or maybe a year.

As in any situation, there are some exceptions, and everyone has a unique story. Some people say that they derive pain relief from Synvisc-One® (hylan-G-F 20) or glucosamine, even though such results are not based on hard science, but these products do nothing to lubricate the joint or build cartilage. Nevertheless, I tried them.

I did physical therapy focused on strengthening my knees. I took glucosamine. I did Synvisc-One injections. I did cortisone injections and took 600-1200 mg of Aleve liquid gels daily. The Aleve worked in bringing the pain down from a high of 8 to a low of 5 on the visual analog scale. Everything else was no-go. I still intend to recommend to my patients all of the modalities that failed for me. Even if a small percentage of patients do well, these modalities are so minimally invasive that there is no harm in trying. So go for it. But if your x-rays show that your knees are done, then they are probably done.

Denial works, though. "Who needs to run or even walk quickly anymore?" I thought. "There are more than enough Netflix and Amazon TV series to avoid ever needing to leave the couch." So what if it takes me 15 minutes to walk across the street.

This line of thinking begins to run thin. Life is motion, and motion is life. But being in denial helped me hold out for 4-6 months, until nearly everyone I knew was saying, "When are you finally going to do something about that knee?"

"All right, already," I replied. "I'll go get major surgery so you don't have to feel so much pain when you watch me walk!"

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