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A Patient Story

New Knees for Skis

Sam Doppelt, MD, Chief of Orthopaedics, and Maria Policelli, PA-C

Sam Doppelt, MD and Anthony Parisi"Kudos to all the professionals at CHA, and thank you. Dr. Doppelt's surgical skills allowed me to continue skiing in 2010 at the age of 73!" - Anthony Parisi, double knee replacement patient

Anthony, a healthy 69-year-old man, came into my office in July of 2006 with bilateral knee pain. He was semi-retired and worked at the TD Bank Garden. This required him to climb stairs during events, which was getting increasingly difficult.

While reviewing his medical record, I read that his PCP noted no major co-morbidities and no allergies. His only current medications were Lipitor and Prilosec. He was also taking NSAIDS to dull the pain, without much therapeutic value. He had no past history of joint pain or knee injury. He was extremely active, married with children, a former hockey player, and an avid skier.

During my initial exam, Anthony mentioned that his pain intensified with damp and rainy weather, a common complaint. He also stated that the pain was sometimes accompanied by knee buckling and instability, particularly in his right knee. This suggested cartilage damage.

The next step was to order x-rays of both knees and an MRI of the right knee. These showed arthritic changes in both knees, and a meniscal tear on the right side. We decided to first try cortisone treatments to see if this would help - with no luck. We then booked surgery to repair his meniscus.

In August 2006, I saw Anthony again for his surgical pre-evaluation. He now had pain with weight bearing, and reported further knee buckling - this time on the left side! After further testing we identified meniscal tears in both knees, chronic sinovitis, and medical plica, a thin wall of fibrous tissue in the left knee. The right knee had similar findings, and also a chondral defect in the articular (hyaline) cartilage, which is common with excessive wear.

We discussed the findings and Anthony decided to move forward with arthroscopy in both knees. This is the least invasive surgical option that could provide the greatest benefit. In September 2006 we did a left knee arthroscopy, and in October, the right. While doing the right knee we also cleaned up the torn cartilage (chrondoplasty).

When Anthony came to see me in January 2007, I could tell that he was still in pain. He was walking with an assistive device, and reported continued pain going up and down stairs. He also mentioned a grinding sensation in his left knee.

I suspected he was an excellent candidate for knee replacement, and discussed it with him. But before committing to this we decided to continue his more conservative treatment. This consisted of oral anti-inflammatory medications, steroid injections, and neoprene braces.

I saw Anthony again in February 2007 - with little change - and then again in April. By now, he reported pain in both knees 7/8 out of 10. The pain was worse with activity, and his quality of life was further diminished. We discussed his situation in detail, and we agreed on total knee replacement.

Over the next few weeks, Anthony worked with our team to gain medical clearances and to participate in pre-surgery education. Our comprehensive program uses a well-tested clinical pathway and includes things like dental clearance, EKG, lab work, informed consent, a pre-op evaluation by our anesthesiology and physical therapy team, and work with our outstanding nursing staff. (Since this time, we have developed an enhanced education program managed by Maria Policelli, PA-C, and Lee Golden, RNFA).

Just 6 weeks later, Anthony came in for his left knee replacement. He came through surgery with flying colors, and did short term inpatient rehabilitation. By August, he was much happier. He had no functional limitations and minimal left knee pain. He still had some residual muscle weakness, and continued to report pain in his right knee. However, after coming through the first surgery, Anthony knew this could be corrected as well.

In June 2008, we did Anthony's right knee, with another excellent recovery. By Spring 2009, he was back to his old habits - skiing again, and doing all his normal daily activities.

When I last saw Anthony, he continued to be in good health and good spirits, ready for another winter season on the slopes. Not bad for a 73-year old!

If you have a patient with arthritic or worsening knee or joint pain, we want to help. Call us at 617-665-1566 for an evaluation.