Lessons from the other side of the knife☆,☆☆,★

https://doi.org/10.1054/arth.2003.50065Get rights and content

Abstract

The overall success or failure of knee arthroplasty is predicated on the successful combination of patient selection, meticulous surgical technique, and prosthetic design. Discussions regarding the outcome of knee arthroplasty frequently focus on the implants used and the surgical technique employed, with a less frequent focus on patient profile. However, the patient experience was further highlighted to me when I became the patient and experienced the consequences of knee arthroplasty firsthand. This experience offered me a greater insight into patient expectations, the importance of preoperative counseling, the severity of perioperative pain, and the issues involved in the rehabilitative period. Joint arthroplasty outcomes are dependent on the harmony existing between the patient's perioperative status, expectation level, motivational status, physician diagnostic and surgical skill, and the design characteristics of the prosthesis. © 2003 Elsevier Inc. All rights reserved.

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Personal history

Playing football in high school resulted in an injury to my right knee involving the lateral meniscus and anterior cruciate ligament (ACL). In 1955, the state of the art in orthopaedics for meniscal injuries was arthrotomy and complete removal of the meniscus. Anterior cruciate repairs were not attempted. Eventually, I returned to playing football; however I had gross knee instability. I wore a derotation brace that was bulky and cumbersome, but it did provide knee stability. After medical

The event

In 30 years of performing joint arthroplasty, I have aspired to give my patients the environment that I was now seeking. These elements include surgeon, hospital, anesthesiologist, internist, and support system. I wanted a surgeon who was experienced and technically competent. I wanted a hospital system with tertiary support. I preferred regional anesthesia with a pre-emptive analgesia program for pain management. I wanted competent medical coverage with particular attention to the prophylaxis

Complications

Shortly after my knee arthroplasty, I developed persistent dysentery. My medical consultants diagnosed antibiotic-induced colitis and suspected Clostridium difficile. Although I was in reasonably good health at the time of surgery, I had been exposed previously to clostridium difficile through patient encounters. The diarrhea continued for an extended period of time. I lost 20 pounds and remained weak and inactive despite antibiotic treatment. Finally, after 3 months, the gastrointestinal

New direction

As so often happens, 8 to 10 months after my right knee arthroplasty, my left knee became problematic. I had injured my left knee years earlier while involved in long distance running. At the time of the injury I denied the symptoms; however, within a short period a large Baker's cyst developed and I underwent arthroscopy with chondroplasty. At the time of arthroscopy, degenerative changes of the medial meniscus and articular damage were identified. The left knee had progressive degeneration of

Personal perspective and observations

As I reflect on my experience with knee surgeries, I am reminded of how far we have come in orthopaedics. Especially in the practice of sports medicine, there has been great advancement. I am certain that my total knee arthroplasty would have been delayed, if not actually avoided, had I undergone a right partial meniscectomy and ACL repair at the time of initial injury. Wise consultation would have directed me away from contact sports such as football. As a practicing orthopaedic surgeon I am

Acknowledgements

The author expresses his sincere appreciation to Adolph V. Lombardi, Jr., MD, and John A. Repicci, DDS, MD, for their superb knowledge and surgical skills, their patience and encouragement, and for the excellent care they provided to him. The author also wishes to acknowledge Joanne B. Adams, BFA, and Kathleen L. Dodds, RN, BS for their editorial assistance.

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No benefits or funds were received in support of this study.

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Reprint requests: Thomas H. Mallory, MD, c/o Joint Implant Surgeons, 720 East Broad Street, Columbus, OH 43215.

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Copyright © 2003 Elsevier Inc. All rights reserved.