Joining the ranks of bionic-boomers, I had a partial knee replacement in April. It’s all the rage according to the press. In the weeks leading up to the surgery it seemed as though every rag or mag I picked up had an article about baby boomers “demanding” knee, hip, or shoulder replacements. As has become typical with such stories, baby boomers were cast in the role of selfish, reality-denying individuals who get what they want and won’t take “no” for an answer. Typical of the tone in such articles is the following, “Across the United States, baby boomers’ passion for competing in marathons, triathlons, basketball and tennis has worn out knees, hips and shoulders in middle age. As a result, this group is undergoing joint replacement sooner to get on with their lives.”
As someone who has never competed in any of those events I find the assumption disingenuous. No doubt there are the Type-A’s who are clamoring to feel 20 again but in my humble opinion baby boomers are getting joints replaced because of a Perfect Storm of health insurance, technology, and education in the 21st Century. My knee surgery would have never occurred without those three blessed items and I’m certain many baby boomers agree.
My knees began disintegrating in my late 30s when I noticed a subtle grinding and occasional click. I was an avid golfer at the time and insisted on walking the course when I could. Golf is hardly the high-impact sport implied by the articles I have read. My knees disintegrated more from genetics than high living. My problem is arthritis of the kneecap, a rather specialized version of knee arthritis afflicting 8-10% of those who present with osteoarthritis of the knee. Like the charming Agnes Gooch of the delightful movie Auntie Mame when people ask what I did that caused this problem I can say simply, “I lived.” My fraternal grandmother had the same problem and my 42-year old niece is starting to notice the symptoms. For those of us with this type of knee arthritis problems come primarily when climbing stairs, hills or inclines. Squatting or getting up from chairs isn’t much fun either. Walking is doable although that was also becoming difficult as the years progressed.
I suffered with pain for many years and used conventional treatment (medication, physical therapy) to good effect but time was not on my side. Eight or nine years ago my doctor proclaimed that knee surgery was in my future. “You’ll know when,” he sagely intoned. That “when” occurred in January 2011 while engaging in the pedestrian activity of making my bed. As I pushed on the mattress with my knee (dumb, dumb, dumb) there was a searing pain that nearly took me to the ground. X-rays showed a gigantic bone spur on the top of my knee cap. The image brought to mind a Viking boat outfitted with a large battering ram because that had been the net effect. The bone spur had rammed into the soft tissue around my knee and was very effective at crippling me for several days.
This was two weeks before a scheduled medical mission to Haiti. A shot of cortisone and RICE therapy (rest, ice, compression, elevation) helped me decide that I could do the mission and I did, but not without great discomfort. There were stairs everywhere in Haiti and more than once I had to stop mid-flight because the pain was so severe. I flashed on the story that my mother would tell about Grandmother Annie hoisting herself up the stairs at night “on her bum.” My mother’s assumption was that Annie was worn out from raising ten kids and was too tired to climb the stairs but I painfully realized the truth — she couldn’t climb the stairs because it was simply to painful to do so. In Haiti I realized that Annie’s knees were now in my body.
The trip convinced me that the time had come to do something. Bit by bit I had been letting go of the things in life that I enjoyed because of the pain I experienced from my knees. Golf and hiking had slipped away and now my knees were threatening to end an experience that I had come to love, medical missions to foreign countries.
Fortunately I had the means to do something about it. Make no mistake, if health insurance, either private or Medicare, didn’t exist we would not see the baby boomers clamoring for prosthetics. It wouldn’t matter how good the technology might be, without the means to pay for it I doubt that many of us would take the plunge. My insurance company was billed $39,000 by the hospital and $17,000 by the surgeon. (The amount that was allowed by the insurance carrier was different, of course, and that’s a topic for another day.) There were numerous other charges from doctors I don’t recall seeing plus home care after surgery and physical therapy for seven weeks. Without the guarantee of some payment these procedures would not take place. No doubt there were cutting edge treatments in Annie’s day but there was no money to pursue them and Medicare was only a dream.
The third factor of this Perfect Prosthetic Storm is education. Baby boomers are highly educated and the tools at hand are extraordinary. The internet provided not only endless articles on knee surgeries — both technical and general — but it also provided the means to compare physicians and facilities, at least here in the State of Florida. During one of my endless Google searches I came across FloridaHealthFinder.gov and found a treasure trove of data that was invaluable. Much to my delight I was able to find a section at that site entitled “Hip and Knee Replacements” and it gave comparisons of doctors (number of surgeries performed broken down by facilities). If you’re having a knee replaced do you want a doctor that has done 40 in the last year or 160! Another site was able to tell me if registered doctors had been sued for malpractice or any other legal action. Armed with this education I was confident going into surgery and this, I believe, contributed to its success.
And if I needed any further evidence of the importance of all this web searching in reaching my determination it was provided to me on my last day of physical therapy. The closing 15 minutes of each session was spent on a table with an ice “blanket” wrapped around my knee. Cold water is pumped through this high tech blanket and light compression applied to the knee. On this last day I had company on the neighboring table, a rather frail late-70s-something lady who I had frequently seen during my six weeks of sessions. She was not having a good day and I noticed that she seemed less competent than she had been in previous sessions. Her therapist noticed too and had her get on the neighboring table so he could “have a look at your knee.” Whatever he saw was enough to shift him into action. He placed an “ice blanket” on her knee and told her to “relax while I try to reach your doctor.” We started to chat and she relayed the sad story of her knee surgery. She was in her third month of PT, I was in my sixth week and graduating. She wished she could “walk as well as you do.” I tried to be encouraging but as she chronicled the problems following surgery — a blood clot, hematomas, a trip to the ER after she was released to home, weeks of pain — it was hard to be a cheerleader. But what made it all the more chilling to me was her doctor. You see, her surgeon had been my doctor for eight or nine years. It was he who had sagely intoned, “You’ll know when.” And when I did know when I was prepared to go with him to the operating table. After all, I had been treated by him for all that time and he is a nice guy. But after I returned from Haiti and met with him specifically to discuss surgery things began to change. He dismissed any consideration of a partial knee replacement and went a step further declaring that my left knee was “about a year behind my right” so I might want to consider a bi-lateral knee replacement. Gulp!
I left the office shaken but still with confidence in my doctor. A friend encouraged me to seek at least a second opinion and it was her encouragement that sent me back to my internist for a referral to another surgeon. With the help of the internet I was able to compare doctors and, in the final analysis, there was no comparison. The new surgeon with whom I consulted saw what the first surgeon didn’t, arthritis that was seemingly confined to the kneecap. He recommended a partial replacement, on one knee, with the option to do a total knee replacement if warranted. It wasn’t. He did the partial, which took him about four times longer than a total knee replacement would have because the partial replacement must be fitted to existing knee components, a total knee is just it says, a total knee. I’ve been told that some surgeons can replace a total knee in about twenty minutes.
But I’m lucky. I have probably 95% of my original knee, and, as my surgeon said, “God makes better knees than I do.” My recovery has been excellent and even though there is still some tenderness I can walk up stairs with much less discomfort. Oh, and there was no sign of deterioration in the other two compartments of my knee.
So, through a Perfect Storm of health insurance, technology, and education I am looking forward to a better life, happy with the simple joys of climbing stairs and being out of pain. This bionic baby boomer is, once again, grateful to the times in which she lives. ❧