I’VE SPENT THE LAST two summers getting new knees. Total replacements, the right knee in the summer of 2023; the left, in 2024.
It has been a long journey. The first orthopedic surgeon I saw spent about five minutes with me before coming up with the wrong diagnosis.
“It’s probably gout,” he said. “That happens with older people.”
“Gout?” I asked. “You mean what Henry the VIII had?”
“Anyone can get gout,” he said, barely giving me another glance.
But it wasn’t gout. The odds of a woman my age having gout in her knee are very small. Gout usually presents as a flare-up of great pain, often in the big toe, not as a gradually aching knee joint. King George III, Benjamin Franklin and Thomas Jefferson all had gout, but not me.
No, the culprit in my case was osteoarthritis, a diagnosis arrived at with a new orthopedic surgeon and one that is increasingly common. A study of 2,600 skeletons found that the rate of knee osteoarthritis has gone from 6% to 16%, more than doubling, since 1940. Although longer life spans and obesity may be factors, another possible cause is the inactivity wrought by the industrial age and, more recently, the time spent sitting while looking at screens.
I tried many things before going for the major surgery option: steroid shots, lubricating (“hyaluronic acid”) injections, anti-inflammatories, physical therapy, acupuncture, and a minor procedure (“subchondroplasty”) that involved injecting a cement-like substance into my knee. I did not try eggshell membrane but hey, whatever works. I was trying to strike the balance between getting the replacement too soon, when it might wear out, and too late, when recovery can be even harder.
As I went through all that, my very wise internist reminded me that “your knee will tell you when it’s time.”
And so it did. It got to the point where it hurt to walk around the block.
And when the time came, I was not alone. The American Academy of Orthopedic Surgeons (AAOS) reported over 140,974 total hip replacements and 254,345 total knee replacements were performed in 2023, an 18% increase over the year before.
The average ages of total joint replacement recipients skew older: 65.6 years old for new hips, 67.6 for new knees. By gender, more women (58.6%) than men (41.4%) get new parts.
Getting back on your feet after knee surgery
Knee replacements used to be really scary. But things have definitely improved. Per the AAOS report, the average hospital stay for a total knee replacement declined from 2.9 days in 2012 to 1.1 days in 2023. Patients discharged to skilled nursing facilities after the procedure is down to less than 5%.
The statistics on outcomes are also good. Ninety-two percent of those getting new hips reported “meaningful improvement” one-year post-op; for knees, patient-reported improvement was 87.2%.
But statistics and good doctors can only take you so far. What happens after that average 1.1 days in the hospital matters, a lot. The first few weeks found me largely medicated. I was lucky to have free in-home round-the-clock care. My partner is an excellent cook, making lentil stews and nourishing soups, even though the pain meds made me nauseous, and all I really wanted was Noosa yogurt.
The summer of 2024 was not a bad time to spend watching television (remember the Paris Olympics!) At one point my partner deemed it safe to leave me in front of the TV while he went for a walk.
“Anything happen while I was out?” he asked when he got back, smirking a little, since I hadn’t left the bed.
“Not much. Biden dropped out and endorsed Kamala,” I answered, feeling a glimmer of hope and not just about my knee.
Ah, well.
Yearning for single stories and well-paved streets
But the real recovery, and the work, came later. Physical therapy is mandatory, and relentless. For months I would let loose a string of sailor-level swearing every single time I went up the old-fashioned, steep staircase in our house. I gained newfound appreciation for “age-friendly” steps of moderate height, handrails, smooth sidewalks and well-paved streets.
As for going downstairs, well, let’s just call it a work in progress.
Along the way I had many, many conversations with people, either about the new knees they have or the ones they might have to get — the dreaded “organ recitals” at gatherings of people my age. If demographics are any indication, the number of people with new parts will only go up. According to a study by the Retirement Income Institute, more than 11,200 Baby Boomers will turn 65 through 2027.
That’s 22,400+ knees.
Most of the people who’ve been through this still hear from their new joints on occasion, and it’s not always good. Carol, a Fort Bragg resident, had her knee done and says it’s worse than before. Her shoulder replacement, however, has worked out well. “Look, I can raise my arm,” she said. “And I can type again!”
Most of the time, I just feel lucky to live in a time when new parts are available and have statistically proven good results.
Given her passion for writing, being able to type without shoulder pain is a true gift.
Another friend, with two new knees and a slightly lunatic bent, recently went sand-skiing in Peru.
As for me, I have permanently switched from running to walking. I usually use walking sticks. It turns out that placing the stick at the right angle and really pushing off gives you speed and an upper body workout. And yes, the sticks have occasionally saved me from a fall. The other day I fell down because it was muddy. My heart skipped several beats but both knees were fine.
There are times when I forget about all of it. On my first post-surgical plane trip, I practically had to strip down before realizing that the beeping was caused by something in my knee, not in my pocket. Now I — and many of my fellow travelers — trudge over to that special scanning portico.
But most of the time, I just feel lucky to live in a time when new parts are available and have statistically proven good results. That first doctor — he of the gout diagnosis — had told me that I could maybe lead a “semi-sedentary” lifestyle. He was wrong. Two months after my first replacement, my partner and I went to see our favorite band in Cloverdale on a hot summer night. For the first time in months, I could dance without thinking (much) about my knee.
My phone, in my pocket, later reported that I had danced 2.9 miles.
STANFORD TO HOST HEALTHY AGING EVENT MAY 5
Aging is an all-encompassing process, involving our bodies, minds, and the assumptions, accurate or not, of ourselves and others. The second annual Healthy Aging event will delve into all of these topics in an event held in person and on Zoom Monday, May 5, from 9:30 a.m. to 4:30 p.m. This year’s theme is Mind and Body.
The day’s activities are sponsored by the Stanford Lifestyle Medicine Program, which seeks to bring evidence-based health information to patients, and The Longevity Project, an organization that fosters research and public conversation about the implications of longer life spans. Experts on fitness and nutrition, sleep, social connection, health tech, and mindfulness will share the latest research, ideas and tips on how to live not just longer but in good health, mentally and physically.
The event will include presentations by Chip Conley, founder of a “midlife wisdom school” called the Modern Elder Academy; Deepak Chopra, a best-selling author and one of the world’s leading voices on wellness and mindfulness; and University of San Francisco psychologist Elissa Epel on the science behind stress and “the powerful connection between stress and the aging process.”
Other panels will address new research into the effect of body temperature on physical and mental health, fitness routines for every age, strength training, healthy diets, brain health and healthy sleep strategies.
The Longevity Project’s Emma Kindsvatter urges anyone trying to separate fact from fiction and filter out the “the noise in the longevity space” to attend. The event’s goals are to “really dive into mental and social health and its connection to longevity” and “bring the experts together to teach people what they need to know about healthy aging.”
Early bird pricing, before April 1, is $139 to attend in person at Stanford’s La Ka Shing Center, and $39 to attend via Zoom. After April 1, prices will be $159 (in-person) and $49 (Zoom). Discounts are available for Stanford affiliates. For more information and to register, visit the Longevity Project website, or download the full agenda.
What does a longer lifespan mean to you? Two talented columnists tag-team every Friday to tackle the challenges that inform your choices — whether you’re pushing 17 or 70. Recent Stanford Center on Longevity Visiting Scholar Susan Nash looks at life experiences through an acerbic personal lens, while longtime writer and health reporter Tony Hicks takes the macro view to examine how society will change as the aging population grows ever larger. Check in every Friday to expand your vision of living the long game and send us your feedback, column suggestions and ideas for future coverage to newsroom@baycitynews.com.
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