An active mother of two teenagers, Karen Ferriera, 48, of San Jose, Calif., couldn’t afford to be sidelined for long. Her oldest daughter was looking at colleges, taking the family on frequent trips. And in her spare time, Karen loved to hike the hills behind her home with her dogs, and spend hours in her garden. So when her doctor proposed a partial knee replacement as a remedy for her arthritis, she hesitated. But she was running out of options.
“I don’t think I wanted to admit that it was that bad,” she says. “But I wore a brace all the time, I was in constant pain, and we just kept upping the pain pills I was taking.”
Arthritis runs in Karen’s family, and a couple years earlier, at age 68, her father had a total knee replacement. While his recovery was easier than expected, it still seemed like a major step to Karen. Wasn’t she about 20 years too young for this procedure? she wondered. Would she be off her feet for months, a year even, only to need surgery again sometime down the line? Imagine her surprise when her surgeon described what she could expect—and it came true.
“I walked out of the surgical center,” she says. “Within two weeks I was taking the dogs around the block.”
Karen is part of a growing population: People who have knee replacements in their 40s and 50s. “We used to tell patients, ‘Grin and bear it as long as you possibly can, because they have a high complication rate or they don’t last,’ “ says Dr. Geoffrey Westrich, associate professor of orthopedic surgery at the Hospital for Special Surgery, Weil-Cornell Medical College in New York. “But that is old-school thinking. The technology is so good nowadays that we can take a younger patient who has advanced arthritis, do that replacement and return them to a quality of life they haven’t seen in years.”
One of the significant evolutions in joint replacement surgery is the development of custom implants. “Before I’d have six or seven sizes, and I’d have to make them fit for everyone,” says Dr. Maury Harwood, an orthopedic surgeon who performed Karen’s replacement. “They didn’t fit all that well, and they wore out fast.”
Now, following a CT scan and the construction of a 3D model, a prosthesis can be custom made for an individual patient.
“It’s a huge philosophy change in orthopedics,” says Dr. Harwood. “You don’t have one kind of spare tire for every car on the road.”
The custom implants also simplify the surgery, often necessitating fewer bone cuts and less blood loss, reducing the risk to patients and shortening recovery time. A partial knee replacement with custom implant is an outpatient procedure that usually takes about an hour, Harwood says. Like Karen, most patients can put their full weight on the leg within days, walk without assistance within a few weeks, and return to a rigorous exercise routine in several months. That increased mobility is crucial for arthritis sufferers, since building muscle and maintaining a healthy weight helps take strain off the joints.
“I told Karen, ‘This is going to put your knee back the way it was. Even if it only lasts five years, I’ve given you five good years back in your healthy lifestyle,’” Harwood says. “It bridged the gap for her, allowed her to be active and live her life.”
But while patients in their 40s and 50s still need to be prepared for the idea that they may need a second replacement surgery, termed a “revision,” today’s replacements are holding up for far longer than in the past.
“The revision systems and technology and the surgery itself have improved so much that we’re now able to tell patients, ‘This replacement could last you many years, but when and if you have to have a revision, it’s going to be even better,’“ Westrich says.
With some of the improvements, he says, about 95 percent of joint replacements are fine after 10 years, 85 percent are fine after 15 years, and 75 percent are fine after 20 years.
For Karen, the difference in quality of life—for however long it lasts—has been worth it. Last summer, just a few months before her surgery, Karen and her family went to Honolulu, Hawaii. While her husband and kids hiked Diamond Head, she had to stay behind. But when they made a return trip this summer, she triumphantly climbed to the top.
“Now that I’ve gone through the surgery, if I had to do it again, I would,” Karen says. “It used to be that everything revolved around my knee and what I couldn’t do. Now it’s never a worry.”