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Listen-up Ladies: Don’t postpone
knee-replacement surgery
Newswise — Is getting new knees on your list of New Year's
resolutions?
Research at the University of Delaware indicates that women wait
longer to pursue knee-replacement surgery
than men do.
By postponing surgery until they can no longer stand the pain,
these women may also risk putting their
mobility, and quality of life, on hold
indefinitely, according to Lynn Snyder-Mackler,
Distinguished Alumni Professor in UD's
Department of Physical Therapy and a
certified sports physical therapist and
athletic trainer.
“Doctors typically tell patients to wait to have knee replacements
until they just can't stand the pain any
longer,” Snyder-Mackler said. “Our research
shows that's bad advice--and worse for women
than it is for men--because your level of
function going into surgery generally
dictates your level of function after
surgery,” she noted.
Snyder-Mackler led the research team for the study, which was
funded by a $1,125,000 million grant from
the National Institutes of Health. Her
collaborators included Stephanie Petterson,
who earned her doctorate in physical therapy
and was a postdoctoral researcher at UD, and
is now a senior lecturer at the University
of East London, and Drs. Leo Raisis and Alex
Bodenstab, orthopedic surgeons at First
State Orthopaedics in Newark, Del.
At UD's Physical Therapy Clinic in McKinly Laboratory, 229
candidates for total knee replacements,
including 95 men and 126 women with
osteoarthritis, were evaluated and compared
to 44 healthy men and women who matched them
in gender, age and body-mass index. Each
subject took part in a series of standard
physical tests such as stair climbing and
the distance covered in a six-minute walk.
The strength of the participants' quadriceps--the major thigh
muscle that extends and straightens the
knee--and range of motion of the knee also
were assessed at the UD clinic, which
handles more than 300 visits by patients
each week.
While the men generally were stronger and had more knee function
than the women, the test results showed a
much greater degree of physical disability
in the female knee-replacement candidates
compared to the males in the group.
“The women afflicted with osteoarthritis were at a much more
advanced stage than the men with the
disease,” Snyder-Mackler said. “The women
all had painful end-stage osteoarthritis,
where the cushion of cartilage padding the
knee bones has completely deteriorated and
you basically have bone hitting against
bone.”
Why are women waiting so long before pursuing surgery?
Snyder-Mackler says there may be a number of reasons. Perhaps women
can bear pain better than men, or a woman's
world increasingly revolves around the home
as we age, or it could be that women are
just trying to follow doctor's orders.
“Osteoarthritis of the knee is the most common cause of disability
among Americans. It's a disease of age that
affects more women than men on a 60-40
basis,” Snyder-Mackler said. “Physicians
generally have advised patients to wait as
long as they can before pursuing knee
replacements, with the thinking that it is a
once-in-a-lifetime surgery that should last
an average of 20 years. However, delaying
surgery can limit the quality of life of
patients because how they function before
surgery indicates their performance
afterward.”
Women need to become more educated about the risks and benefits of
knee-replacement surgery, Snyder-Mackler
said, and heed the warning signs of serious
problems.
“When you feel profound buckling and weakness in your knee when
climbing stairs, that is a major problem.
You compensate--eventually, you may come
downstairs only once a day,” Snyder-Mackler
said. “As a result, you become sedentary and
that's not good for your health. Earlier
intervention can help preserve your mobility
and quality of life.”
The research is one of two UD studies led by Snyder-Mackler and
reported in the Journal of Bone and Joint
Surgery.
In a related study, Snyder-Mackler worked with Dan Ramsey,
assistant professor of exercise and
nutrition science at the University of
Buffalo, and UD colleagues Kristin Briem,
physical therapist, and Michael Axe,
clinical professor of physical therapy, to
determine the effectiveness of “unloader”
knee braces in reducing pain and improving
function in osteoarthritis patients.
The research, which also was supported by the National Institutes
of Health, showed that these braces actually
promote pain relief by diminishing muscle
contractions rather than by “unloading” or
separating the joints. Such knee braces may
provide an inexpensive treatment option for
some osteoarthritis patients.
Snyder-Mackler says she has always been interested in research on
knee injuries, and in providing solutions to
improve people's lives.
“I've always had a burning desire to bring evidence to bear on
clinical problems--that's always been really
important to me,” Snyder-Mackler said.
“There are real people at the end of the
research loop--patients, physical therapists
and physicians, and the patients' families.”
