Susan Donahue was in pain and scheduled for bilateral knee replacement surgery at New England Baptist Hospital the next day. But she played tennis anyway—convincing evidence that she loves the sport and that she had the motivation required to face a more challenging rehabilitation than if she had surgery on one knee.
That was four years ago. Today, Mrs. Donahue, 61, is pain-free and as active as ever. “I am playing tennis four days a week and enjoying every minute of it, thanks to Dr. Scott,” she says, referring to Richard Scott, MD, the respected NEBH joint replacement surgeon who performed her bilateral knee replacement. A former college player and instructor, she has returned to a high level of competition.
“I’m playing better since having the surgery—much better than I did during the four years leading to it,” says the Norwell resident, who had been in pain for several years and on a steady diet of Advil. “Three arthroscopic surgeries repaired my meniscus and got me back on the court.”
When it was time to get serious about repairing her knees, she sought out Dr. Scott. “I wanted the guy who is considered to be the guru,” she explains. “Besides, I’m aware of the Baptist’s quality metrics.” Mrs. Donahue, an informed medical consumer, has served as a board member at area hospitals. She specifically wanted to avoid an infection. NEBH’s impressive post-surgical infection rate is well below that of other hospitals and continues to drop—to less than 0.5 percent.
The goal is to avoid complications
In many ways, Mrs. Donahue was an ideal candidate for having both knees replaced at the same time. Otherwise healthy and active, she told Dr. Scott that her goal was to have bilateral replacement.
“I rarely initiate the possibility of doing two knees at once,” Dr. Scott notes. “I’d rather the patient talk me into it, because it’s not for everyone. The rehabilitation period is a bit longer and more difficult, so the motivation needs to be there. Similarly, someone with a low pain threshold may not be a good candidate for bilateral surgery.
“First, I need to determine if both knees are ready to be replaced. Both need to be truly symptomatic, not just arthritic, on their x-ray. If someone has a severe flexion contracture, where they can’t straighten their legs, or a severe deformity, such as bowing of the legs, they are more likely to be a candidate for bilateral surgery.”
Mrs. Donahue had gradually become knock-kneed. With her knees abnormally close together, and her ankles spread far apart, she couldn’t stand up straight. “It has to do with how the cartilage in the joint wears,” says Dr. Scott. “Some people are simply out of alignment, similar to what can happen with the front end of a car.” Once in surgery, Dr. Scott determined that Mrs. Donahue could have a partial knee replacement on one of her knees, which is a less radical surgery than a total knee replacement.
Most importantly, the individual who requests bilateral knee replacement surgery must be cleared medically. “They cannot have a significant cardiac history—in fact, no problems with the major organ systems,” he says. “In patients who have diabetes, it must be well-controlled.” As a precaution to prevent deep-vein thrombosis (blood clots), all bilateral knee patients take blood-thinning medication for a month.
Obese individuals are known to have a higher rate of surgical complications, so he asks that these patients lose weight in advance of surgery. “If they lose weight, it shows they are motivated,” he says. “Also, the force on our knees is triple what we weigh, so if someone loses ten pounds, they’ve taken 30 pounds of pressure off their knees. I’ve had people lose weight and cancel their surgery because they’re not in pain anymore.”
Four months after surgery, back on the court
As an active sports enthusiast since her high school days, Mrs. Donahue was more than ready for her post-surgical rehabilitation. She attended the Baptist’s class for patients who are scheduled for joint replacement surgery and headed to her surgery with confidence. “They came and got me out of bed the evening of my surgery,” she recalls. “The care at the Baptist was extraordinary.”
Four days later, she was discharged to a rehab facility. “They work you hard, but it was worth it,” says Mrs. Donahue. Although she was driving one month after her surgery, her focus was on returning to tennis. The trainer at Scituate Racquet & Fitness, where Mrs. Donahue plays, contacted Dr. Scott’s office for guidance on exercises that would help her continue to make safe progress.
In August, four months after her surgery, Mrs. Donahue picked up a racquet and tried to play. “I was terrified, because I didn’t know what to expect,” she recalls. “I had no confidence and was afraid I would fall.” She got over that quickly; by October, she was again playing tennis competitively.
Mrs. Donahue appreciates the counsel she received from Dr. Scott. “He encouraged me to be sensible and stick with just playing doubles, and that’s what I’m doing,” she says. “In addition to Dr. Scott’s quiet confidence, he’s a wonderful listener. He understands what makes you tick and works with you to reach your goals.”
She has encouraged friends to not put off having knee replacement surgery. “I don’t understand why people say they want to put off the surgery as long as they can, because today’s implants are designed to last,” she says.
Dr. Scott says that statistics prove her point. “The myth is that knees are like a battery that wears out,” he says. “It is true there is an annual attrition rate, but it’s much better than it used to be. About 90 percent of patients can expect to get 20 years from their knee replacement, and 85 percent can expect to get 30 years. If you’re severely disabled, why wait? You’re giving up years when you could be enjoying yourself.”
He finds that people know when they’re ready for surgery. “I see the whole spectrum, from the person who wants a knee replacement because their knee swells when they run ten miles, to the person who is in a wheelchair,” he says. “Most people are somewhere between those two extremes.”
As for having both knees replaced at once, when their rehabilitation is over, Dr. Scott always asks patients if they are glad they decided to make one trip to the OR. “The vast majority say they are very happy they had bilateral knee replacement.”