“Your knee being skewered by an ice pick — that’s how I described the pain before I had surgery. If that is a 10, the level of pain now is zero,” said Charles Abrachinsky.
“For some reason, I knelt on the bed to get in,” said Elinore Dunphy. “I heard a snap and then felt excruciating pain. ‘Bone on bone,’ the doctor called it.”
Abrachinsky, age 70, is a tall, big man who has worked in the concrete floored, refrigerated environment of the meat business all his life. Dunphy, 78, is a little lady with delicate features who stayed home to raise her family before working behind a desk for many years. Abrachinsky gave his knees a workout as a high school and college football player. As a young woman in Washington, D.C., after World War II, Dunphy loved to dance; the jitterbug was one of her favorites. Both retired to Ocean View, both found their retirement hampered by the pain of arthritis, and both are knee replacement surgery success stories.
Abrachinsky and Dunphy share the same diagnosis, osteoarthritis.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), osteoarthritis is the most common form of arthritis. It is a joint disease that mostly affects cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over each other. It also helps absorb the shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together.
The rubbing causes pain, swelling and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage.
Osteoarthritis occurs most commonly in older people, people who have had a specific joint injury, and people whose occupation or choice of exercise has placed unusual stress on their joints. Like many other medical conditions, it is also most disabling in people who are overweight.
Unlike some other forms of arthritis (there are more than 100), osteoarthritis affects only joints and not internal organs. The disease can attack any joint but it occurs most often in the hands, knees, hips, and spine. Warning signs of osteoarthritis are:
• Steady or on-and-off pain in a joint;
• Stiffness in a joint after getting out of bed or sitting for a long time;
• Swelling or tenderness in one or more joints; and
• A crunching feeling or the sound of bone rubbing on bone.
No single test can diagnose osteoarthritis. Physicians use a combination of medical history, physical exam, X-rays, blood tests and exams of the fluids in joints to diagnose the disease and rule out other problems.
The statistics about arthritis are astounding. It is the nation’s top cause of disability and costs the U.S. economy nearly $86.2 billion annually in lost wages. In Delaware in 2003, the percentage of adults with physician-diagnosed arthritis was 34 percent.
The treatment goals for osteoarthritis are to improve joint care through rest and exercise, keep a healthy body weight, achieve a healthy lifestyle and control pain. There are numerous choices of pain medications, dietary supplements and alternative therapies, both those needing a prescription and over-the-counter. Each has pros and cons and requires the counsel of a physician who knows the individual patient and their other bodily maladies.
However, when the pain in the knees and hips becomes extreme, there is a surgical option that is performed successfully, with such regularity that it has become routine. Just look at the knees of people over middle age walking on the boardwalk or aqua-exercising at the pool. The vertical scar down the center of the knee has become a symbol of camaraderie for many regular exercisers.
Like many who contemplate knee surgery, Abrachinsky and Dunphy chose their surgeon as a result of word-of-mouth referrals. Dunphy went to Dr. James Trauger, who practices at Peninsula Regional Medical Center in Salisbury. Abrachinsky, who sings in the choir at St. Ann’s Church, found Dr. Wilson Choy, who practices at Beebe Medical Center, from fellow chorister, Rita Studzinski.
The joint at the knee is like a hinge. It extends and flexes. The joint at the hip is like a ball and socket. It needs to abduct (move away from the body) and adduct (move back towards the body again), as well as flex and extend.
An arthritic or damaged joint is removed and replaced with an artificial joint called a prosthesis.
According to the American Academy of Orthopaedic Surgeons, the prosthesis is generally composed of two parts, a metal piece that fits snugly into a matching sturdy polyethylene plastic piece. Several metals are used, including stainless steel, alloys of cobalt and chrome, and titanium. Most older persons can expect their total joint replacement to last a decade or more. Younger patients may need a second total joint replacement.
Orthopaedic surgeons recommend total joint replacement when the pain is unrelieved by other treatment options, and is so severe and continuous that the person starts to avoid using the joint, thus weakening the muscle around it and making it even more difficult to move.
Once the orthopaedist has recommended surgery, it is up to the patient to decide when. “My biggest recommendation to fellow sufferers is not to delay,” said Abrachinsky.
Marie Berntsen, coordinator of the orthopaedic service line at Beebe Medical Center, concurs. “Often patients come and have one knee done. Then they return for the second and say, ‘I just wish I had had surgery sooner. The difference is like night and day.’”
More than 600 joint replacement procedures are performed at Beebe every year. Every week, a class is given at the hospital for patients scheduled for surgery. Dot Chimienti, the instructor, tells participants that she was an operating room nurse for 25 years.
“When I started,” she said, “patients were hospitalized for two weeks. Now it averages three to four days.” In the past, almost all patients received general anesthesia. Now most patients have spinal anesthesia along with some sedation. Chimienti shows a movie that was filmed at the hospital. It explains the process patients can expect and emphasizes the teamwork of all the professionals involved. In fact in 2005, HealthGrades, a provider of independent hospital ratings, ranked Beebe as the top hospital in Delaware for joint replacement surgery.
As well as watching the movie, class participants meet different members of the joint replacement team and are given the opportunity for all their questions to be answered. One of the booklets in the package they are given is entitled “Intimacy After Joint Replacement.” The subject is a common concern for prospective patients. The booklet informs, “The news is good. In fact, it is likely you can return to sex sooner than many other activities.”
Patients begin walking, under the supervision of a physical therapist, the day following surgery. If they have help at home, many patients are discharged home. Others, depending on their insurance, go to an outpatient therapy center or a skilled nursing facility for a week to 10 days to make sure they can mange independently. All are scheduled for about six weeks of outpatient physical therapy.