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Lisa Steinkamp has a simple message for people – especially active people like herself – about getting a knee replacement.
“Don’t put up with the pain and lack of function,” says Dr. Steinkamp, who directs the Doctor of Physical Therapy Program at the University of Wisconsin School of Medicine and Public Health. “Get the new knee and enjoy more of the activities you have been missing out on.”
Until about 20 years ago, the “conventional wisdom” regarding knee replacements was to live with discomfort as long as possible because an artificial knee would only last 10 to 15 years. Then it will be time for another replacement.
While this line of thinking may have been sound years ago, there is much better news for today’s patients.
“Contemporary artificial knees are significantly more durable,” says Dr. Brian Nickel, a UW Health orthopedic knee-and-hip surgeon who performed Lisa’s knee replacement in late 2020. “The plastic and biomaterials are significantly better than they were 20 years ago, which means the artificial joint lasts much longer and the incidence of failure today is a fraction of what it has been historically.”
Lisa was 61 when she decided to pursue surgery and her story was familiar. Several years of playing soccer in college led to tearing both menisci, nature’s shock absorbers, in her left knee. At just 19, she underwent surgery to remove the menisci – not just the torn segments – because that was standard practice at the time. Unfortunately, this left Lisa with a bone-on-bone knee by the time she finished school. She gave up running, tennis and other high-impact sports, but still maintained a heavy regimen of cycling, hiking, skiing, water skiing, golf and weight-lifting.
Like driving a car with balding tires, a substandard knee like Lisa’s can only take so much wear and tear. By the time she was in her 40s, engaging in her favorite activities invariably resulted in painful swelling followed by several days of “paying the price.”
“I’d ski or hike for an hour and it would get super swollen,” Lisa says. “Then I’d battle through and end up hobbling around for a few days. It wasn’t pleasant, but I still thought of surgery as a last resort.”
Dr. Nickel told Lisa her life could improve greatly with surgery
Finally in 2020, the situation worsened enough to merit a visit with an orthopedic surgeon. Dr. Nickel, a fellowship trained knee-and-hip specialist who performs more than 700 joint replacements annually, told Lisa that she didn’t have to go on suffering.
“We discussed the reality that she didn’t have to give up the things she enjoyed,” Nickel says. “Lisa also was an excellent candidate for outpatient surgery, which meant she could be walking about two hours after surgery is completed and on her way home a few hours after that.”
While it’s not for everyone, same-day joint-replacement surgery at UW Health has become increasingly popular, especially for younger, more active patients and those who have a good caregiver at home.
“We work with the patient to determine whether same-day surgery or an overnight stay is best for them,” says Nickel. Moreover, he adds, most knee/hip replacement patients receive regional (spinal) anesthesia with gentle sedation, which is safer than general anesthesia.
“It doesn’t take as long for patients to wake up and recover, yet they still have no memory of anything during the operation,” Nickel says. “Why didn’t I have surgery sooner?”
Nickel tells his patients that the first two weeks after surgery are the toughest, and Lisa doesn’t disagree. By a month out, however, she was feeling great. She was hiking at eight weeks, snowshoeing at 10 weeks and skiing as hard as she has at 12 weeks.
“These felt like monumental achievements,” Lisa says. “Of course I was asking myself why I didn’t have the surgery several years earlier.” As a physical therapist, Lisa also reminds prospective patients that they are likely to come out of surgery stronger if they go into surgery stronger – just one more benefit to having surgery at a younger age.
Regardless of whether the patient’s primary goal is greater function, like Lisa, or pain relief from an arthritic knee, Nickel and his UW Health orthopedic colleagues can help on both counts.
“With today’s artificial knees being made better and lasting longer, many patients can have a replacement in their 50s or 60s with little chance of needing a revision or redo surgery,” says Nickel. “We also encourage patients to consider a center like UW Health, where joint replacement surgeons perform only hip and knee replacements and accumulate high volumes of first-time replacement patients. Our team,” Nickel adds, “also has great experience performing complex revision surgeries on patients who are referred from greater distances. As part of a tertiary academic center, our team offers a skill set that is second-to-none regionally and is consistently ranked as one of the top orthopedic hospitals in the country by U.S. News & World Report.”