85-Year-Old-Refuses to Give In

Murray Ginsburg started running for his high-school team and has not stopped exercising daily in more than 70 years.

When he turned 75 and his knees began to give him problems, he stopped jogging and switched to 13-mile-long walks in the surrounding areas of his home in Coral Gables.

Last year, however, he began to have pain in his right hip. Initially, he could handle it, but it increased gradually. When Ginsburg, now 85, found that he couldn't walk eight miles without pain, he decided it was time to get help.

Ginsburg is one of 1.1 million patients each year in the United States who, according to the National Center of Health Statistics, undergo hip- or knee-replacement surgery.

The number of patients keeps growing because of higher life expectancy, as well as a dramatic rise in the obesity rate, which accelerates joint degeneration. By 2030, the number of surgeries is projected to be 4.5 million, according to the American Association of Hip and Knee Surgeons .

Most of the damage in joints is caused by osteoarthritis, also known as arthrosis, or wear and tear. It is the degeneration of the cartilage that serves as a cushion between bones.

This tissue tends to erode with age. But there are also other factors, such as being overweight, injuries, excessive wear and tear and other illnesses that contribute to its erosion. Recent studies have also demonstrated that there is a hereditary factor that accelerates this process.

With wear and tear, cartilages lose fluidity and gets rough, causing pain in the bones that rub against each other. The discomfort is most acute when the tissue erodes completely and there is direct friction between the bones.

"The first symptom is pain and rigidity in the joints," says Dr. Michaela Schneiderbauer , a surgeon specialist in hip and knee transplants and assistant professor of orthopedics at University of Miami's Miller School of Medicine . "Osteoarthritis is an illness that progresses, and the pain grows with time."

It is the progressive nature of the illness that makes it more predominant among the older population.

"As we grow older, cartilages erode. This process begins at about age 30 and in its first stage does not present symptoms or discomfort," says Schneiderbauer, explaining that "once the joint's deterioration reaches a certain point, usually at age 50 or 60, the pain begins."

Traumatologists have various options of treating patients who have mild or medium arthritis in the joints. Occasionally there is improvement with changes in lifestyle — specialized therapy or exercise, the use of canes or splints, or simply losing weight.

"People don't expect a surgeon to tell them that they should lose weight, but if they are patients in the first stages of the illness, which is when they can improve the symptoms and keep their natural knee or joint, it is my duty to tell them," Schneiderbauer says.

"Excess weight in the body multiplies by four or five times in the knees. If a patient loses 20 pounds, it is as if 80 pounds have been removed from his knees."

The symptoms of mild or medium arthritis can also be controlled by anti-inflammatory medication such as aspirin, acetaminophen or ibuprofen and other oral supplements like glucosamine and chondroitin.

There are cases that require injections of corticosteroids, an anti-inflammatory agent, or hyaluronate therapy, which changes the fluid in the joint, among other medications. However, these options do not always bring relief to those with more severe arthritis, so specialists resort to partial or total reconstruction of the joints to alleviate the pain and recover mobility.

"This surgery is designed for patients who have already received more conservative treatments but who still have pain and functional limitations that affect their everyday life," says Dr. Alexander van der Ven , an orthopedic surgeon who specializes in the reconstruction of knees and hips at Doctors Hospital in Coral Gables.

"It's the patient's quality of life that determines when surgery is necessary," Schneiderbauer says. "If your everyday life is consumed by pain, it is time to consider surgery."

That is the case of Caridad García, 51, who last year had both knees replaced after years of discomfort. "I couldn't remain standing for even two seconds, I could hardly walk or sleep at night," says García, who had to leave her job because she could hardly move. "I began to limp to compensate for the pain and got so used to walking that way that when people told me, 'You're limping,' I would insist that I wasn't."

Both hip and knee surgeries are based on the same principle — the surgeon replaces, partially or totally, the joints that are not working correctly with new artificial parts.

In the case of a knee, the damaged ends of the bones and the cartilage are replaced with metallic and plastic parts. This allows for recovery of motion.

For hips, the head of the femur is replaced with a metallic part that has the same shape and is connected with a metallic rod introduced in the femur. Then a plastic cavity is implanted in the pelvis to replace the damaged one. Plastic cement can be used to attach the bone to the prosthesis or implant the replacement in such a way that the surrounding bone can grow.

Doctors Hospital's van der Ven says that while one of the main concerns with this type of surgery had been the components' durability, technological advances in the materials have significantly extended the life of prostheses and replacements.

"With the use of new types of plastic, the wear and tear of materials has ceased to be a problem," he says.

"It's a combination of elements. We have improved the way the surgery is performed, the techniques we use and the implants' materials," says Dr. Preetesh Patel , orthopedic surgeon at the Cleveland Clinic of Florida . "Today, we can expect the knees we replace to last more than 20 years."

The surgery's success depends on how well the new joints are aligned, which makes good preparation a must. With the help of X rays, or in some cases MRIs, the doctor determines the areas that need replacement and orders the necessary prostheses, which come in different sizes and measurements.

"We do a sketch or template before surgery and based on it we choose the products we're going to need. Then we measure again during surgery to make sure the patient has the prosthesis properly fit," Schneiderbauer says.

"Ninety-five percent of patients obtain exceptional results. Yet three or five patients with knee-replacement surgeries do not find their problems solved and still have limitations," says Patel, who offers his patients customized prostheses to increase the chances of success. "These instruments are totally adapted to the patient's needs, the joint alignment, its rotation and anatomy, so they end up fitting like a glove."

The use of this type of prosthesis requires more initial tests, among them a sequential magnetic resonance test to determine the exact measurements and functioning of the parts, which are more expensive than standard ones.

However, Patel says this type of surgery requires fewer instruments than traditional knee replacements — only one or two trays of surgical instruments, versus six or eight required in standard replacements. In addition, there is less recovery time for the patient.

Most patients who have gone through hip- or knee-replacement surgery stand up the same day of the operation or the following day, depending on the conditions of each case.

Physical therapy is recommended to help the body adapt to the prosthesis and reeducate the surrounding muscles, which for years have functioned in an altered fashion to compensate for the pain in the joint.

Patients are expected to be walking without a cane or a walker four to six weeks after knee surgery. It might take longer for hip surgery, partly because some doctors prefer to wait four to six weeks before beginning physical therapy to give the implant a better chance of attaching firmly to the femur.

Once patients recover from surgery, they can lead a normal life. Specialists recommend staying active and exercise, though excluding activities with a high impact, like jogging.

"Exercise is absolutely necessary and critical for a successful replacement," van der Ven says.

"The only thing I regret is not having had the surgery earlier," says García, who had her right knee operated in April 2011 and the left one six months later, in October.

"One fears how everything is going to work out, but my advice to those who suffer from bad knees is to just do it," says the grandmother, who has finally realized her dream of taking her grandchildren to DisneyWorld. "And I could walk through the park with them!" she adds, laughing.

Meanwhile, Ginsburg continues his post-surgery recovery therapy after his hip replacement in November 2011. He is training to take part in the ING Miami Marathon next year. "I'm already walking two-and-a-half to three miles every two days, and my goal is to walk half a marathon of 13.1 miles in January of next year."