I have been advising my patients to exercise, keep active and walk as long as they can in order to stay mobile and healthy. However, seniors often tell me activities that require prolonged weight bearing or walking are limited by knee pain from arthritis. Six years ago, I discussed this topic and used Dr. Joseph Andriole as an example of someone who had severe osteoarthritis in his knees. Yet, he continued to be very active and enjoyed retirement skiing and golfing. However, over time the pain and loss of function became too great and he did go on to have his knees replaced a few years ago. He is doing great…golfing and skiing again. So, the next question is, how do you know when you’re ready for a new knee?
Harry Schmaltz, MD, a local orthopaedic surgeon who performs knee replacement surgery on a regular basis, feels that most patients know when they are ready for a knee replacement. Often, they wait until they can no longer endure the pain and beg to have it done ASAP! Others are very content with their inactive lifestyle and, for them; the risk of surgery is not worth the benefit. Dr. Schmaltz feels that everyone has a unique “trigger” to make the decision and they often state, “I am sick and tired of my knee interfering with my life!” For example, for one it may be the inability to babysit grandchildren and for another it may be they are unable to play golf.
However, it may be that many, in an attempt to “tough it out” wait too long and create a host of other problems. For example, Joe Traino, a retired nursing home administrator from Dalton, has suffered from knee pain due to arthritis for almost 10 years. During this time he has seen several changes; he has lost his ability to walk more than 1-2 blocks or climb stairs without severe pain. Also, he is unable to use a treadmill, bike, elliptical or stepper for aerobic exercise. As a result of his inactivity, he has gained a significant amount of weight. At age 67, he is unable to enjoy traveling with his family due to his inability to walk. In addition to weight gain, his sedentary lifestyle has lead to high blood pressure and sleep apnea. Over time, it is likely to lead to coronary artery disease and adult onset diabetes. Consequently, the arthritic pain in his knee has contributed to many health issues over the past 5-8 years.
Recently, in a conversation with Joe and his wife Judy, I pointed out that, in addition to the health problems created by inactivity, he may be missing out on the best years of his life. Why wait to get a new knee when your 75 or 80 and may have other health problems that limit travel and activity? If you get a new knee when your 65 or 70 then you can enjoy what may be the healthiest 10 years remaining. While surgery should never be taken lightly and is always the last option, sometimes it is the best choice.
Score each question below as follows:
Extreme Difficulty or Unable to Perform =0
Quite a Bit of Difficulty =1
Moderate Difficulty =2
A Little Bit of Difficulty =3
No Difficulty =4
Usual work, housework, daily activities: Score___
Hobbies, recreational activities, sports: Score___
Safely get in and out of a bathtub: Score___
Walking between rooms: Score___
Putting on shoes and socks: Score___
Lifting objects (like a bag of groceries) from the floor: Score___
Performing light daily activities at home: Score___
Performing heavy activities at home: Score___
Getting in or out of a car: Score___
Walking 2 blocks: Score___
Walking a mile: Score___
Going up or down 10 stairs: Score___
Standing for one hour: Score___
Sitting for one hour: Score___
Running or walking fast on even ground: Score___
Running or walking fast on uneven ground: Score___
Making sharp turns while walking fast: Score___
Hopping or a skip step: Score___
Rolling or turning in bed: Score___
TOTAL SCORE _________/80
Scoring: The higher the score the more functional you are and less likely to need surgery for a new knee. For example, 80 out of 80 total points is normal. 60 and above is fairly functional. 40 to 50 points is a danger zone and below 40 you might start talking to your doctor about a surgery. By the way, my friend Joe Traino scored 34 points…whether he knows it or not, he is ready!
SOURCES: Lower Extremity Functional Scale; American Physical Therapy Association
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune.
Read Part 1 on Knee Arthritis.
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org.
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton and is an associate professor of clinical medicine at The Commonwealth Medical College.