CHICAGO (Mar. 24, 2014) — Bonnie Pittman of LaSalle, Ill., never thought a routine total knee replacement would disable her.
“My leg got worse, not better,” Pittman recalled. “I thought, ‘I can’t live like this.’ I had to do something.”
Following surgery, excessive scar tissue formed in her knee joint and surrounding soft tissue, stiffening her knee. The condition is known as arthrofibrosis, or “stiff knee syndrome.”
The first surgery
55 years young, Pittman had delayed knee replacement surgery, due to her age. Most doctors recommend waiting until 65 before getting a new knee. But arthritis had set in, breaking down the cartilage in the joint and causing extreme pain.
“It got to a point where it was bone on bone,” she said.
Pittman was limping to compensate for the pain. Physical therapy and cortisone shots only helped temporarily. In February 2013, she decided to move forward with a total knee replacement at a hospital near her north central Illinois home.
She felt the opposite of improvement after surgery. Despite weeks of physical therapy, Pittman said, “I couldn’t walk or straighten my leg. If I sat down, I couldn’t get up.”
The pain and inability to bend her knee affected her entire body. “I was hunched over. I threw out my back. I put more pressure on my other leg to walk as best I could.” Pittman became depressed. “I was too young to be crippled.”
So Pittman took action and sought out a specialist for a second surgery nine months later.
Fixing surgery with low-dose radiation and surgery
“When I first saw Mrs. Pittman, she had very limited range of motion to her knee,” said Henry Finn, M.D., chief of surgery at Weiss Memorial Hospital, medical director of the Chicago Center for Orthopedics at Weiss, and professor of Orthopedic Surgery at the University of Chicago.
“Her range of motion was 40 to 75 degrees (normal is 0 to 130 degrees), which is debilitating, but I knew we could improve her range of motion based on our research and past experience to the point where she could lead a more normal life again.”
Dr. Finn specializes in complex knee and hip revision surgeries. He is among only several orthopedic surgeons in the world with enough experience to treat arthrofibrosis.
Dr. Finn authored a study on surgical treatment for arthrofibrosis, published in the Journal of Arthroplasty in the September 2013 issue (Vol. 28, Issue 8, Pages 1314-1320). The treatment involves exposing the affected knee to low-dose radiation prior to surgery. Dr. Finn said he and other surgeons had been using low-dose radiation to prevent excessive scar and bone formation following hip revisions. Plastic surgeons have used low-dose radiation to prevent excessive scarring for years.
“It made sense to apply it to the knee, and we found it works well,” he added. “The radiation essentially prepares the body for another procedure by turning off the scar- and bone-forming cells that come with surgical trauma,” Dr. Finn explained.
The findings come at a time when more patients are expected to develop arthrofibrosis following their initial knee replacement. Surgeons in the United States alone perform more than 600,000 knee replacements each year, according to the Agency for Healthcare Research and Quality.
Some researchers estimate that number will spike to 1.4 million in 2015, with revision surgeries due to a stiff knee also increasing. Currently, about 10 percent of knee replacements are “revision” surgeries, and Dr. Finn estimates about half of all revisions involves arthrofibrosis to some degree.
Scar tissue is frustrating to both doctors and patients. Many patients have multiple surgical attempts with recurrence of arthrofibrosis.
For Pittman’s revision surgery, following the low-dose radiation treatment, Dr. Finn installed special implants with built-in stability to allow him to remove scar tissues, including ligaments, which were blocking range of motion. He said the two-step procedure gives patients another chance.
“We take the original knee replacement out, surgically remove the scar tissue limiting motion, and revise the knee with a more stabilized implant (e.g. Finn Knee™). These devices are not dependent on ligaments for stability,” he said.
Pittman reported dramatically different results the second time around. A day following surgery, she said she could “feel the difference.”
This time she was quickly on the road to a full recovery. In a matter of days, her knee extension was fully restored – from 0 to 120 degrees.
“I would have been physically disabled the rest of my life if I didn’t pursue another surgery,” Pittman said. “Dr. Finn gave me my life back.”
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