Surgery on joints can restore mobility, lifestyle

Wearing a black pencil skirt revealing a 10-inch scar that goes through her knee Lorri Winter walks across the room with swagger showing what she playfully calls her "America's Next Top Model" walk.

Three months following knee replacement surgery swagger isn't the only thing Winter has gotten back.

"My life is back," says the 49-year-old Elmhurst resident. "Things I enjoy I can do again."

Originally Winter was told she was too young for surgery and an X-ray showed no damage. But after months of physical therapy followed by steroid injections and wearing a brace — still with little relief — she sought a second opinion.

"I went to the zoo and I was wearing my brace. I did everything I was supposed to and I left in tears I was in so much pain," Winter says.

The second surgeon reviewed her X-ray and an MRI showing her knee was bone on bone and suggested knee replacement.

Joint effort

Many people are finding renewed movement through joint replacement surgery, but it isn't an in and out fix.

"People have a misconception that it's a simple operation and when you are done everything will be normal, almost like a bionic joint. It's not bionic, but it's a wonderful operation," Phillip Ludkowski, orthopedic surgeon with the Illinois Bone & Joint Institute, says of joint replacement.

No matter what the problem with the joint, Ludkowski says surgery is not done at the first sign of pain or discomfort.

People need to understand surgery is only half of it and joint replacement requires a large commitment to rehabilitation afterwards, especially for a knee.

If you go to a well-respected surgeon it is rare to offer surgery on a first visit, Ludkowski says.

"We do try everything to maximize conservative treatment," he says.

Ludkowski says typically a surgeon will get a detailed history and take X-rays to determine or confirm the cause or course of the pain. He says while the pain might be in the knee or hip it could be caused by a problem elsewhere, like the spine.

But when other routes don't work and it is a joint issue, surgery may be the next step.

Step up to surgery

So what does a joint replacement entail?

"Most patients think you are taking out a knee like you take out a carburetor and put in a new knee like putting in a new carburetor," Ludkowski says. The misconception is not surprising since it is called total knee replacement surgery, but it involves replacing the surface of the thigh, shin and kneecap bones with prosthesis made of metal and plastic. For the hip, Ludkowski says, it does involve removing the ball and replacing it and repairing the hip socket.

The precision comes in making sure the joint is straight and properly aligned and the ligaments are all balanced.

"It's a complex operation to do properly," he says.

Ludkowski says going into hip or knee surgery it is good to remember the numbers two and three.

Surgery typically requires two to three days in the hospital for observation and recovery. Patients will often require the use of a walker or crutches for two to three weeks and have to participate in physical therapy for two to three months. It is usually several weeks before the patient can drive and returning to work depends on the activity level of the job.

While those who have had joint replacement in the past may remember the pain post-surgery, Ludkowski says pain management has improved greatly in the past five years with the use of nerve blockers immediately post-surgery.

"Consequently the patients get off to a real good start," he says.

Post surgery

For the patient the real work begins post surgery. Ludkowski says physical therapy first involves learning to move safely with transfers and trying to lessen the risk of falling. The next objective for the knee patient is to strengthen it and increase the range of motion.

This might also include modalities such as icing or cold treatments to help with swelling.

Ludkowski says most patients do use prescription pain medication for a few weeks to a few months — usually prior to a physical therapy session or to help them sleep.

Hip replacements candidates can see major differences within three months.

Ludkowski says people may get back to regular activity or those they had to stop because of pain.

"Low impact activities are encouraged," Ludkowski says. "That's why you had the surgery, to have an active lifestyle, to have a healthier lifestyle."

It is a resurgence of life that Winter says has been worth the work.

"You've got to do the physical therapy even though it's hard and painful and you've got to do exercises at home too," she says.

It was four weeks of extreme pain and seven before things looked a little brighter for Winter. Having a sense of humor and laughing with her therapist helped.

Winter knew she was on the right track when she was standing on uneven ground at a Civil War reenactment doing something she loves — taking photographs.

Shooting from the hip

Ruth Richter, 72, had a similar outcome following two hip replacement surgeries. After two or three years of pain, she found out she had a congenital problem known as hip dysplasia. The pain was not constant, but acute and intermittent effecting her hips, buttocks and back.

"I gave up a lot of things but most important for me was walking my dog and keeping up with my neighbors," Richter says. "My housework probably suffered too. You don't realize how important walking is to you until you have to give it up."

She found she couldn't go to the Chicago Botanic Gardens, concerts at Ravinia or the Lyric Opera because they required too much walking.

"I was giving up a lot of really great stuff," she says.

The first hip surgery was done in May, but not long after that she was ready to see the same improvement on the other hip.

"I was anxious to get it done," she says. "The first went so well I didn't see a reason not to."

Now several weeks after her surgery, Richter says the procedure and recovery were a breeze and she is up to walking 2.5 blocks.

"I have a smile on my face," she says. "I had a lot of encouragement. I wasted two unnecessary years when I should have gotten it done."

Not by the numbers

While the average age in the U.S. for joint replacement is 68, Ludkowski says it does depend on the person and their health.

"You can't make decisions on age alone. Age is a consideration but doesn't discount anyone," he says. "We look at the overall health."

He says it is a team approach with general practitioners and any specialists giving the go ahead.

Ludkowski has performed knee surgery on a 21-year-old woman with rheumatoid arthritis and a year ago performed hip replacement surgery on Harold Weaks three days after his 103rd birthday, believed to be the world record for the oldest joint replacement.

Marlys Weary, speaking on behalf of her father Harold, says he had a lot of hip pain on his right side prior to the surgery. It kept him from walking the block and a half from their Mount Prospect home to the library where he has volunteered for 42 years. Harold was grateful Ludkowski was willing to perform the surgery.

"The next day I was on my feet and the pain was gone," Harold says.

He completed the physical therapy and celebrated his 104th birthday in October fishing off his grandson's pier on the Potomac River.

"He is able now to walk around the condo without assistance," says Marlys adding he uses a cane outdoors.

"I think he was a surprise to a lot of people, but people who know my dad are glad to see him up and around," she says.

Winter says the surgical results will give her a better quality of life for the next 15 to 20 years — when the knee may need to be replaced again, she figures the science will have progressed even further.

"It was the right choice. I'm not ruining my other knee and hips (compensating for the bad knee)," Winter says. "I'm able to work out again which is better for my longevity and basic health."

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