The question most often asked by longtime readers and acquaintances I haven't seen for a while is, “How are your knees?”
They recall the columns I wrote in February 2005, three months after having both knees replaced, in which I described the unexpected, prolonged and poorly treated postoperative pain and the surprising length of recovery time.
I'm dancing again, and in March 2007 I walked all over Sydney, up and down hundreds of steps, for many hours each day with no pain. This past March, I toured Vietnam by bicycle.
But the truth is that artificial knees, while certainly an improvement over severely arthritic ones like mine, are not like normal, healthy knees. There are limitations inherent in the devices and surgical techniques. Although a vast majority of patients ultimately fare really well, in some cases the device fails or there are lasting injuries to tissues.
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No warning about pain
Studies of many hundreds of patients with total knee replacements show potential problems that surgeons may fail to mention in advance. In one study, the main issues for patients were pain, difficulty with the activities of daily living, and recovery time.
Perhaps the most important finding is that patients are often told that they will be at a certain level of recovery in a certain length of time, which often leads to unrealistic expectations.
For example, I had been told that I would be driving in four weeks when I still wasn't ready to drive in eight. And I needed potent pain medication for four months.
What about the long-term results?
Kneeling is problematic, making activities like gardening a challenge.
Going down steep steps can be difficult and may require a sideways approach.
Despite months of physical therapy, there can be residual discomfort. I “feel” my knees on every rotation of the bike pedals, though the sensation is not what I would call pain.
Most artificial knees are metal and set off the security alarm at airports, requiring a personal scan with a wand. This may be moot when new body scanners are in place.
Some patients require a surgical revision within two years of a replacement because of technical problems.
As one surgeon reported in 2005, 52 percent of knee replacement patients experienced functional limits, versus 22 percent among other people their age.
Some orthopedic surgeons are using new equipment and techniques that can improve the success of knee replacements.
My own bottom line? My new knees are a significant improvement and I'm not at all sorry I had the surgery.