Ask the Expert: Dr. Friedrich Boettner, Orthopedic Surgeon, Answers Your Questions About Total Knee & Hip Replacements & Resurfacing
Q1. I am in my 50s and enjoy running marathons. Will the impact from this activity eventually hurt my knees to the point where I may need a knee replacement?
Not everyone who runs marathons will need knee replacement. However, if knee pain is something you experience after running I would recommend discussing it with your doctor. If you already have cartilage damage in your knee running may hasten the need for surgery. You also might be at greater risk for cartilage damage from running if you are obese or your knees are rather bowed (varus deformity). Both conditions will increase the load on your inside cartilage and this could over time result in arthritis.
Q2. How often can one get an injection of Synvisc to relieve knee pain before it doesn’t work anymore?
Everyone is different. If someone has had a few months of pain relief from the injection, but then the effects start to diminish, an option could be to repeat the injection. However, if the injection does not provide relief I would recommend to talk to you doctor about other ways to relieve your pain. Usually I do not recommend more than one Synvisc injection a year. You also need to know that Synvisc consists of chicken protein and repeat injections have been associated with local allergic reactions and painful swelling of the knee.
I think the current literature does not support the routine use of PRP for arthritis. Most insurance companies do not cover the cost of the injection because of a lack of supporting research. In general there are always patients that benefit from treatments like this, however, the overall percentage is not high enough to generally recommend PRP injections for people with arthritis of the knee.
Q4. My hip hurts now even when I sleep. How do I know if I should consider a hip replacement? I hate to miss time off from work.
Once your doctor has told you that your x-ray shows a considerable amount of arthritis and you have attempted non-operative treatments like anti-inflammatories (etc.) pain waking you up at night is usually a sign that you should consider a hip replacement. In any case you should now take the time to discuss this with your orthopedic surgeon.
Q5. How long after a knee replacement can I drive again? Why do I have to wait if it’s not the knee I use for the pedals?
I recommend waiting an average of 3-4 weeks after a knee replacement to drive. Most patients use narcotic pain medication in the first four weeks after surgery. You can not drive while you are on these medications since they interfere with your ability to drive. Also, after the surgery there are specific exercises which need to be done to keep the knee flexible. Sitting in a driving position for a long time could potentially cause swelling and stiffness, no matter which knee is used for the pedals.
Q6. I will be having knee replacement operation shortly. With news every day of devices being recalled, should I ask my doctor for a record of which device my doctor uses?
With the recent news of recalls, it is reassuring for you to know what type of implant will be used. However, implants that have been recalled from the market are no longer available for implantation. Therefore your risk of receiving a recalled implant is very low. Every surgeon has a preferred type of implant and it makes little sense to ask your surgeon to use a specific implant because you like it or heard an advertisement about it. In general differences between implant designs are marginal and not all you hear in TV and print ads is really true. It is better to go for the surgery with the surgeon you like and trust than with a surgeon that uses a particular implant. The greatest concern we all have is that an implant we use today is going to be recalled in the future, therefore, it makes sense not to go with some very new or unproven technology.