Example: a femur that rotates laterally during the terminal swing of the gait cycle so that the knee points out to the side is going to wear the heck out of that poor knee (and probably ankle as well). When you replace that bum knee, what you’re left with is a knee with less pain (statistically) but a still malfunctioning hip joint that’s going to have further consequences down the line (e.g. ankle pain, hip pain/degeneration, lower back pain). I’d much rather someone go see a physical therapist or a postural therapist who’s going to work with them to restore balance to the muscles that contribute to the problem so that, over time, the person gets better. Obviously surgery may be the only option in some cases, but surgery, as you say, really shouldn’t be the first thing that pops into people’s minds when they are old (or young) and have joint pain!

As for nit-picking research studies, I have to disagree. It is absolutely VITAL that health professionals nit pick these studies like crazy because ultimately the patient/client/person in front of you doesn’t care about the results in aggregate. The person cares about all the nuances that affect them as individuals. If you are in the 17% who get no improvement, you’re going to wonder why nobody made clear to you that surgery is not a silver bullet.

I’ve nit-picked the heck out of research studies and am appalled at the kind of statistical half-truths that get pawned off as good science. As someone who clearly does a lot of research-reading, you know what I’m talking about!

When one does surveys, one doesn’t always look at one full end of the positive or negative end of the scale. All the researchers were showing was that the huge majority continued to enjoy golf. That’s all that’s being said. In other words, having a knee replacement doesn’t deter one from enjoying golf. I hear what you are saying, but the point in being nit-picky doesn’t matter. Overall, after a joint arthroplasty, the majority continue to enjoy golfing.

What data was really missing, in my opinion, would be what type of component was used and was there a difference in the satisfaction numbers and walking numbers. Also, how severe was the arthritis prior to the replacement surgery. Also, how much residual weakness? How much fear?

Here’s a nice report current as of 2003 on knee replacements: http://tinyurl.com/yg27ska

Here is a study on total knee replacements where the component looks great and the surgeon would deem the procedure successful, but the patient does not like the outcome because of pain or stiffness. It isn’t always the arthroplasty that has to be considered for a positive outcome: http://tinyurl.com/ybqgw9l

Here is an article on what factors might predict dissatisfaction: http://tinyurl.com/yksx3vy

Patient expectations should also be addressed prior to surgery: http://tinyurl.com/ylndfet

And, just as my role is to know when physical therapy is indicated and when positive outcomes can be achieved, surgeons also need to be able to determine whether the outcome from an arthroplasty will be positive: http://tinyurl.com/yedkt8v

I never stated there were no rotational stress factors on the knee with walking. The rotational stress factors are greater on the knee during golf (in particular the swing) compared to walking.

From a physical therapist’s perspective, quadricep strength is highly important in improving function after a knee replacement. Snyder-Mackler and Mizner have done awesome work on this topic. Here is just one of their articles: http://tinyurl.com/yauj2z4

What we really need, is the ability to have these people think of physical therapists at around the time they first start compensating for their problem, i.e. going up the stairs slightly sideways, hanging onto that handrail more frequently, getting up from a chair or couch with less ease… that is when I believe huge improvement and potentially preventative work could be done.

That 94% statistic is meaningless in my mind. First of all, how much you “enjoy golf” is widely open to interpretation and also to influence by innumerable factors. Imagine you broke your ankle and had to lay off golf for 10 weeks in recovery. Would you enjoy your golf that much more once you’ve recovered? Yeah. I’ve felt that way about hockey after my injuries. Secondly, they combined two groups that should be split in my mind. Those who enjoyed golf more or the same should NOT be part of the same number. If the surgery is that effective, those who enjoy golf more should stand on their own. Since that was probably an underwhelming number (since it’s a bogus thing to measure anyway), they just combined the groups to make it seem very positive. 94%! Wow!

As for less pain, there’s an issue there as well. 17% got no improvement. Of that 17%, how many felt worse? Something about just fixing the knee isn’t working for a good number of people. I would like to see some studies done on knee replacement surgery that compare it to placebo (much like they’ve done with arthroscopic knee surgery) to see how much help comes from the actual joint replacement and how much comes from the strong suggestion that the surgery actually fixes you and the actual rest and recovery period you undergo as a result of the surgery.

For people with knee pain, there are rotational stress forces in the knee when they’re just walking, which is why I think that education is not the missing piece for the non-walkers post-surgery. People with knee pain would be much better off seeing a good physical or postural therapist than having their knees cut out.

Golf is not a considered something not to be done after a knee replacement. Golfing is not a limitation after a knee replacement: http://tinyurl.com/yhjan59

83% of those with a knee replacement reported less pain while golfing after the total knee replacement compared to prior to surgery.

From my perspective as a physical therapist, those with a knee replacement are choosing not to walk because they have fear. They need more education. Walking isn’t what is worrisome with golf – the rotational stress forces during actual golfing would be more problematic from a biomechanical/structural perspective.

~Snippets