At times, Joe Heringhaus will
pause in mid-step, marveling at
how much his life has changed.
Gone is the near-constant pain that
he knew his entire adult life, gone are
the nighttime pangs from an arthritic
knee that would wake him from sound
sleep.
At times, it seems his is a wholly different
life now that he's had knee replacement
surgery.
Heringhaus, a chief with the Covington
Fire Department, was injured
playing football in high school and later
served 25 years "” with an aching knee
"” with the department before retiring
in 2005. By the end of his service, he was
fairly dragging his right leg because of
the pain, he says.
For years, doctors told Heringhaus he
needed knee replacement surgery. He
put it off until his retirement, a move he
now regrets.
"I can't believe how much better my
life is," says Heringhaus. "I wish I had
listened to my doctors and had it done
when they first told me to. I'm walking
around without any pain, and playing
18 holes of golf with my buddies, which
I couldn't do before. Sometimes, I forget
that (the implant) is even there."
Ramona Carr is still waiting for the
day she can forget about her new right
knee implant. Having just had the surgery
in January, she still frets about the
scar and remembers post-operative pain
quite vividly.
Carr, the mayor of New Richmond,
put off her surgery for at least three
years, letting doctors try injections
and other therapies before opting to go
under the knife. As a former EMS chief
and a current manager with the Angels
Above and Beyond home health care
service, she was well-versed on the pain
and rehabilitation involved, and was
reluctant.
She also knew, though, that she
wanted to be able to play with her first
granddaughter, Raegan, who was born
in December.
"So, I finally gave in and had it done,"
says Carr. "Afterwards, the pain when
I woke up that first time made me see
stars, but even then I knew that arthritis
pain was gone. It was amazing."
Six months af ter doctors at Wellington
Orthopaedics performed the
surgery, she's working out on an exercise
bike daily and talking three-mile walks,
pleasures she's been denied for years.
Carr and Heringhaus are just two of
the 1 million patients the American College
of Rheumatology estimates undergo
total joint replacement surgeries each
year, whether it is to replace damaged
or arthritic knees, hips and shoulders,
or even smaller joints "” wrists and
ankles. Medical advancements, especially
during the last decade, have made
the procedures quicker, safer and less
painful. Meanwhile, a growing number
of baby-boomers who want to continue
living active lifestyles are making joint
replacement more commonplace.
"Not long ago, if a patient came to
you with pain from a damaged joint,
the solution was to limit their activity,"
notes Dr. Tim Kremchek, the Reds'
team doctor and a surgeon with Beacon
Orthopaedics and Sports Medicine in
Sharonville.
"The mindset has changed. If you're
an active 45 year old, and you have that
kind of pain, why would you want to
wait 15 years to have something done?"
As recent as a decade ago, younger
patients were discouraged from total
joint replacement because implants
were thought to only last 10-15 years.
Together with pain, rehabilitation expectations
and chances for problemswith new joints, many doctors were
guiding patients to postpone surgery
until later in life, lessening the chances of
having to undergo a second replacement
in their lifetime.
All that has changed, says Dr. Angelo
Colosimo from University Orthopaedic
and Sports Medicine.
Colosimo, Heringhaus' doctor and
the director of Sports Medicine at the
University of Cincinnati Medical Center,
runs down the list: "The prosthesis itself
has changed, the design of it and the
actual makeup of it, the surgical procedure
has changed, the physical therapy
has changed. When I was training at
Duke, a total joint replacement was a
major event. Now, I can do a knee in 45
minutes, and patients can have a normal
life again in weeks. The whole procedure
has advanced tremendously."
"Age played a role, not so much in how
old the patient was, but how many years
they had left because at the time implants
were expected to last eight to ten years,"
agrees Dr. Jerry Magone of Orthopaedic
and Sports Medicine Consultants. "So,
if you had the surgery earlier, you'd end
up having to go through it again when
the implant wore out. You had to remove
the whole implant, a whole new surgery
and the bone was now different. Now,
you can just pop out the plastic pieces
and pop in new ones. Technology has
allowed us to push that envelope, and
take patients earlier.
"I give a lot of credit to engineers,"
continues Magone. "The quality and
design of implants is one area, but even
when we f irst had supermetals and
advanced plastics, we still didn't have
decent equipment to place implants as
precisely as we do today."
Like Colosimo, Magone tried computer-
aided placement systems, but has
gone back to previous methods. "Doctors
who do the number of procedures
we do with the jig system are comfortable
with it and it works. The computer
systems need three points of reference,
like a GPS system, so you have to put
three pins in the bone so the computer
knows where the bone is. So, you have
that additional part of the surgery. Until
those pins are part of the implant itself,
and that extra part of the procedure is
gone, most doctors probably won't be
using computers very much."
Patient Ron Corradini can certainly
attest to advancements in the field.
The former Sycamore High and college
football coach had to wait 15 years
before having surgery to replace his arthritic
left hip. Diagnosed at 35, doctors
told him to hold off until he turned 50
to get his hip replaced. He waited as long
as he could: two months after his 50th
birthday in 1987.
Another 15 years later, in 2002, he had
his right hip replaced.
"It was a big difference," says the retired
teacher and coach.
After his first surgery at Joint Implant
Surgeons in Columbus in 1987, he was
walking with at least a cane for the better
part of a year.
"After the second one, everything
was back to normal within six weeks.
The same doctors did the surgery, but
the surgery itself was just so much more
advanced," he says. Corradini, now
71, lives just off the Jack Nicklaus golf
course in Mason. Without pain in either
hip now, he sometimes wanders out his
back door and plays a few holes of golf
on the course. "I couldn't have done that
before," he says.
Total joint replacement surgery is
complex, but reads like simple carpentry.
O
nce surgeons have access to the joint
"” the hard part of the surgery, Colosimo
says, is not damaging the muscles, nerves
and other soft tissues to get to the bone
"” the ends of the bones of the damaged
joint are removed. Canals in the middle
of remaining bones are hollowed out to
accept rods from an implant, a new joint
made from high-tech plastics, ceramics
and metal.
Once the implant is in place, surgeons
replace the soft tissues and close the
incision.
New practices called "minimally invasive
surgery," with smaller incisions,
are still being refined, though doctors
are divided about its benefits weighed
against potential problems of a misaligned
joint. Doctors are also beginning
to use computers to aid in exact placement
of implants.
After surgery, patients can expect
pain. Doctors are sawing bone, after all,
but in some cases, it's little worse than
the pain they faced every day with their
arthritic joints.
For some, there's little pain at all, like
federal judge Arthur Spiegel. At the age
of 81, he finally gave in and had hip replacement
surgery in 2002 at Deaconess
Hospital.
"My hip had been so painful I could
barely move. It would lock up on me. I
couldn't even sit for very long. It was an
annoyance. No matter how much you
shifted, it was uncomfortable," Judge
Spiegel explains. "I don't recall any pain
from the surgery. Maybe I have a high
threshold for it, or maybe it was because
it didn't compare to what I had been
feeling."
Six years on, Spiegel is still on the
bench, plays tennis regularly with
friends and continues to f ly his own
small aircraft, all without hip pain. He
credits it to the skill of his doctors, and
physical therapy.
Following hip or knee replacements,
patients are often on their feet the same
day, according to protocol. They can
expect a hospital stay of three to five
days, using a walker for a few weeks
before progressing to using a cane while
physical therapy continues.
By far, the longest recovery time comes
with replacing a shoulder.
"It's a more difficult surgery, technically
harder because of the structures
and soft tissues around the joint, and it
has to be done more precisely," Colosimo
explains. "With hips or knees, patients
can use walkers, but after a shoulder they
can't use their upper extremities at all, so
it's a bit harder on the patient."
After being released from the hospital
within three days, patients are restricted
to very limited activity with the arm for
six weeks, using a pulley system to raisethe arm and keep the new joint from
stiffening. They sleep with a sling on the
arm to prevent injuring the new joint.
After a few weeks, patients begin a rehab
program to strengthen the muscles
around their shoulder, which usually
takes another three months.
Elbow, wrist and ankle replacements
are less commonplace, doctors say, a
last-option procedure that is still working
toward the dependability of larger
joint replacements. Smaller bones, the
nature of the joint and the soft tissues
and verves around them mean a
trickier procedure, and greater potential
for problems. With wrists and elbows
rehabilitation time is quicker, but ankles,
because they bear weight, can be slow.
Patients are restricted from putting significant
weight on their new ankle for
up to six weeks.
While the art of joint replacement
surgery has changed dramatically in
recent years, so too have the implants.
Now, finely manufactured and designed
implants may last the rest of the patient's
life.
Changes range from newer designs
that add stability, ceramics that mimic
bone, to newer metals and plastics,
and unprecedented manufacturing
standards, reveals Dr. Tom Lindenfeld
from the Cincinnati Sportsmedicine and
Orthopaedic Center.
"Most of the metals in implants are
the same metals that have been used for
30 years, but the metallurgy is better,
the milling is better, and there's less of
a chance for problems in the future that
we have to revisit surgically," Lindenfeld
says.
In hips, doctors are finding that 90
percent of implants are lasting longer
than 15 years "” as opposed to the
10-year-lifespan doctors expected in
the past "” and 75 percent of implants
are lasting at least 20 years, Lindenfeld
says.
"And that's all from 20-year-old technology,
because patients have to have
had the implants long enough for us
to gauge that information," Lindenfeld
adds. "Today's implants are clearly better.
It's entirely possible that we'll see
them last 30 to 35 years, or even more."
With all the advancements, doctors
are having little trouble finding proponents
for joint replacements. They only
have to look to patients.
"When you have a joint that's boneon-
bone, there aren't a lot of options,"
posits Colosimo, "but I never tel l
someone we have to do it. They tell me.
When they're tired of the pain, they tell
me 'Let's get it done' and they're amazed
afterwards when the pain is gone."
Corradini, his hip implant from 1987
still performing perfectly, has advised
friends to not put joint replacement off,
including his 35-year-old son, who had
a damaged hip replaced last year.
Heringhaus, too, sings the praises
of his new knee to anyone thinking of
undergoing the procedure.
"I tell them, 100 percent, do it. It'll
change your life," he says.