Sixty-eight-year-old Al Vacchiano looks forward to playing tennis two or three times a week. But up until a few months ago, the Huntington, Long Island resident was often sidelined by a bad knee. Severe arthritis put a crimp in his active lifestyle. Hoping to avoid surgery, he tried a variety of over-the-counter creams he saw advertised on television or found in the pharmacy. They provided no relief.
About a year ago, the former stock broker went to see an orthopedic surgeon who told him arthroscopic surgery (a minimally invasive operation that uses tiny incisions and a video camera to see inside the joint) could buy him time so he could delay knee replacement. Mr. Vacchiano went ahead with the procedure. But three months later, he was in worse shape than before the operation. “The arthroscopic surgery was a ‘band-aid’ solution to my problem, and it didn’t work,” he notes.
“Anyone who tells a patient with advanced bone-on-bone arthritis that arthroscopic surgery will relieve the pain – even just for a while – is doing a disservice to the patient,” says Dr. Geoffrey Westrich, co-director of joint replacement research at Hospital for Special Surgery. “Studies show, and we know from experience, that arthroscopic surgery is of no benefit for severe arthritis, yet some doctors continue to recommend it.”
Arthroscopic surgery is generally performed to repair a torn cartilage that is causing problems for the patient, Dr. Westrich notes. “Although minimally invasive surgery may sound like an easy procedure, no operation should be considered a walk in the park. Any type of surgery entails risks and benefits.”
Arthroscopic knee surgery generally involves several weeks of recovery, and in the short-term patients may experience pain, swelling and impaired function. They go to physical therapy to regain normal functioning.
After his first operation failed to provide relief, Mr. Vacchiano says he went to three or four additional orthopedic surgeons for their opinion. “They all said I had bone-on-bone arthritis and I should replace the knee.” Meanwhile, Mr. Vacchiano continued to play tennis on occasion, despite the pain. One day, he happened to be playing doubles on Long Island with a retired orthopedic surgeon. “He noticed I was limping, I told him my story, and he referred me to Dr. Westrich.”
Coincidentally, Dr. Westrich had performed both hip and knee replacements on Mr. Vacchiano’s father-in-law, and he did very well. Mr. Vacchiano quickly made an appointment, making the hour-and-a-half trip to HSS from Huntington.
Dr. Westrich told him he was a good candidate for a partial knee replacement, also called a unicompartmental joint replacement. “The only tried and true treatment for painful, advanced bone-on-bone arthritis is joint replacement,” Dr. Westrich notes. “Sometimes, if the arthritis is limited to just one area of the knee, we can do a partial joint replacement, and this is better for the patient. The recovery is generally faster and we preserve more bone. Since Mr. Vacchiano’s arthritis was limited to the inner part of his right knee, he was an excellent candidate for a partial knee replacement.”
Dr. Westrich notes that it’s important to get the proper diagnosis sooner, rather than later. “If people wait too long, the joint continues to deteriorate, and a partial knee replacement may no longer be an option. At that point, a total joint replacement will be necessary to relieve their pain and restore mobility.”
Mr. Vacchiano is back to playing tennis two or three days a week. It’s an important part of his life -- a social, as well as athletic activity. He is happy to be pain-free and able to resume his active lifestyle. “It’s been amazing, I have complete mobility. I walk on the beach every day with my dogs. I can do everything anyone else can do,” he says.
He has this advice for anyone with severe knee arthritis who is told to have arthroscopic surgery: “It’s a waste of time. I tried to take a short-cut, but it didn’t work out. I’m delighted with the outcome of my knee replacement, and I would recommend it to avoid all the stress I went through with the first procedure that didn’t do any good.”
“When patients see a doctor, it’s often a good idea to get a second opinion, especially if they have advanced arthritis and are told arthroscopic surgery will alleviate their pain,” Dr. Westrich says.