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31st January 2017

Getting a new knee at 73

When Peter Schmelter’s kneecap was shattered into five pieces in an accident 55 years ago, the only option was to stick them back together. 

In 1962, total knee replacements – or TKRs – were still several years away and so Peter, then 18 years old, had to get on with a repaired (and slightly enlarged) knee rather than a new one. Despite this, the 73-year-old has managed to remain active and still rides his bicycle every day. About six months ago, however, Peter decided to undergo TKR surgery.

“I don’t have any pain, but I have no control over my left knee,” Peter tells This Is Medtech. “When I walk down stairs, it’s terrible, and I can’t walk upstairs without the support of my arms leaning heavily on the railing.”

Being such an active man, and having had his right knee replaced several years ago with very limited post-op rehabilitation, Peter knew that he wanted a surgeon with expertise in sports medicine. “I wanted to know how athletes recovered so fast,” he explains.

He already had in mind Professor Dr. Med. Michael Clarius, Chief Physician at the Vulpius Klinik in Bad Rappenau, Germany, an orthopaedic surgeon with an excellent track record in sports medicine who he’d met at a “rapid recovery” congress in April 2015.

One thing that makes Professor Clarius stand out is that he works with a specially designed rapid recovery programme. Before surgery, he and his team particularly support patients in preparation for the operation. For example, Peter has been doing supervised exercises to build up the muscles in his leg so that his body will be ready once the new knee is in place. In addition, he began practising with the crutches he’ll be walking with afterwards. Professor Clarius also works hand-in-hand with the physicians and therapists in charge of his patients’ recovery.

“It’s not just about the surgery itself. The pre- and post-operation is just as important,” says Peter. “Everyone along the pathway needs to work together to ensure success.”

Rapid recovery

A key part of the rapid recovery programme is early mobilisation: Peter should be back on his feet the day of his surgery or shortly thereafter. He will remain in day-time clothes all day long, in a comfortable chair in a living room, without unnecessary bed rest during the day.

Moreover, special attention is placed on ensuring that Peter won’t feel isolated. He’ll have undergone the surgery on the same day as other patients so that they can all go through the programme together, providing each other with support and encouragement. There will be group therapy and coaching by a family member or relative, as well as group physiotherapy sessions.

It will be interesting to hear how this experience compares with his past knee surgeries. Peter will be back to share his post-op story with This Is Medtech in a few months’ time. Be sure to tune in!

SOME FACTS ABOUT TKR

TKR is usually considered when the bone surfaces on both sides of the knee, as well as the underside of the kneecap, are significantly damaged. In TKR surgery, the surface of the thighbone is replaced with a contoured metal component designed to fit the curve of your bone. The surface of the shinbone is typically replaced with a flat metal component and a smooth plastic component that serves as cartilage. The under-surface of the kneecap also may be replaced with an implant made of high tech plastic, or a combination of metal and plastic.1

A National Institutes of Health study concluded that TKR is extremely successful, resulting in “rapid and substantial improvement in the patient’s pain, functional status, and overall health-related quality of life in about 90% of patients”.

In the UK alone, nearly 900,000 people underwent TKR surgery between 2003 and 2015, according to the National Joint Registry. Osteoarthritis was the sole stated indication for surgery in 96% of cases, and more than half of the surgeries were performed on women.

Most people who undergo TKR surgery are 50-80 years old.2

References:

  1. Zimmer, About Knee Replacement
  2. Healthline.com, Clinical Outcomes and Statistics of Knee Replacement