Eric Hicks, 31, of Cedar Lake, Indiana was tired of the pain and surgeries over a decade’s time. A knee injury while playing high school football started him on a course that kept getting worse.
Hicks underwent 8 surgeries since age 18 – mostly arthroscopic procedures to repair tendon and ligament tears as well as damage to the patella. All surgeries resulted in minimal pain relief and little effect on his knee function. But his last surgery in the fall of 2016 resulted in the most severe damage – arthrofibrosis, an aggressive build-up of scar tissue following a total knee replacement. It leads to what’s called “stiff-knee syndrome.” Hicks had limited motion in his knee.
“Prior to the knee replacement, doctors told me I had so much arthritis in my knee that the joint looked like that of a 90-year-old man,” notes the husband and father of two.
Talking about his knee ailments to more senior employees at the international railroad freight company in which he works, they suggested he get a knee replacement, which proved successful for them. “I thought, that’s what I needed, a new knee,” Hicks remembers. He was getting tired of his knee swelling every time he did anything strenuous like playing basketball, hiking with his family or walking. “I could no longer do the activities I wanted to with my boys (ages 7 and 4).” Hicks did undergo a total knee replacement, but resulted in arthrofibrosis and limited motion once again.
The American Academy of Orthopedic Surgeons states there’s no absolute age for a knee replacement surgery. Most surgeons evaluate patients based on pain and disability, and typically recommended it to patients over the age of 50. But in the recent past, researchers note more young adults undergoing these procedures.
“Mr. Hicks was severely disabled when we saw him,” notes world-renowned knee revisionist Henry Finn, M.D., director the Chicago Center for Orthopedics at Weiss Memorial Hospital, and professor of orthopedic surgery at the University of Chicago. Hicks was referred to Dr. Finn following his knee replacement in Indiana. “He was hunched over with limited bend in his knee – only 50 to 75 degrees, which makes it virtually impossible to walk.”
In a 6-month period following his knee replacement, his quality of life quickly declined. “I was depressed,” Hicks remembers. “I lost the ability to do what most people take for granted.”
He had a brace on his leg for support and walked with a cane. “But I never could straighten my leg.” He describes his MRI before surgery for his arthrofibrotic knee: “It looked like dissolved paper floating in water.”
In April 2017, Dr. Finn got Hicks walking tall again with a procedure in which he pioneered for this problem. It involves a 2-step process. First, a treatment involving low-dose radiation exposure to the affected knee prior to surgery. “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 explains. Then, the previous knee implant is taken out and replaced with a rotating-hinged knee, which allows greater freedom of motion. “It was a complicated procedure, and there are long-term concerns because of Mr. Hick’s age.” Hicks is the youngest patient Dr. Finn has treated for arthrofibrosis. Because of Hicks young age, Dr. Finn predicts he will need at least two revisions in his lifetime. Most hinged knee implants last 15 to 25 years.
Hicks says he’ll face those surgeries when they come. For now, he’s amazed at the turnaround in his life.
“I could stand straight for the first time in years, and within hours of surgery I was able to walk,” Hicks says. “My wife was in tears when she saw me walk down the hospital hall.”
Hicks say he never imagined walking the way he used to. “I thought I would never work again and would be in physical therapy the rest of my life.”
But his future is brighter: “I can do everything now. I like to be with my kids. I can walk.” And he expects to return to his physically taxing job by the end of July.
Currently, about 10 percent of knee replacements are “revision” surgeries. An estimated half of all revisions (50,000) involves arthrofibrosis to some degree. The cause is unknown. “There might be a genetic component to arthrofibrosis,” Dr. Finn notes, “but there’s no research to prove that to be true, and I haven’t seen it in my experience.”
Hicks is thankful he connected with Dr. Finn, one of the few surgeons nationwide who is performing the arthrofibrosis procedure. “He knew exactly how to fix me, and here I am. I can bend my knee again.”