Knee Replacement Surgery

The Last Straw

Donna and Bill underwent successful knee replacement surgeryBesides DNA, siblings Donna Andreotti and Bill Nelson share at least two other qualities: a need to stay active and a little stubbornness when it comes to pain. When Andreotti’s right knee began aching several years ago, she suspected osteoarthritis — a disease marked by the cartilage cushion wearing down in the joint and the bones rubbing together. But the 66-year-old dental hygienist kept working and regularly met friends to exercise at a gym near her Milford home.

Bill, her younger brother, later responded similarly to the osteoarthritic pain in his right knee. The 63-year-old retired mechanic knew his “poor knee just took a terrible beating” from kneeling on damp concrete and lifting heavy objects over the years. Plus, he played high school hockey and experienced a bruising winter car accident as an adult. But despite a limp, the Northbridge resident continued his typical routine, doing chores around the house, helping friends and participating in skeet and other sport-shooting contests. “Just go, go, go,” from the minute he woke up to the minute he went to bed, as he describes it. He too, put off seeing a doctor. “Oh, it doesn’t hurt, it doesn’t hurt,” Bill says, recalling his response. “I can deal with it.”

Relief finally came for both siblings with right knee replacements done by Dr. Susan Barrett at Milford Regional — Donna first and then Bill, following his sister’s recommendation. Both siblings applauded Dr. Barrett’s approach to consultations: straightforward and plainspoken, but also compassionate and patient.

I don’t like to tell anyone they need a knee replacement,” says Dr. Barrett, the Medical Center's division chief of orthopedic surgery. “I let them decide when they’ve had enough. Every patient is different when they decide it’s the last straw.”

Knees get to that point after damage from arthritis, with three main types: osteoarthritis from normal wear and tear; rheumatoid arthritis from the immune system mistakenly attacking joints; and post-traumatic arthritis from a serious knee injury.

Dr. Barrett is a board-certified surgeon who specializes in knee and hip replacement. She works closely with local primary care doctors, and provides direct care all the way through treatment, ensuring patients always see a familiar face.

The first step is scheduling an appointment at Mulroy Orthopaedic Surgery & Sports Medicine, a private practice in Milford that includes Dr. Barrett along with Drs. John Mulroy and Michael Vasquez, two other exceptional orthopedic surgeons on staff at Milford Regional.

Consultations include a physical exam, imaging tests and a thorough discussion of the options. Non-surgical approaches can include changing activities, taking medications such as aspirin, undergoing physical therapy or getting injections to relieve pain, curb inflammation or add joint lubrication. An operation is often the most effective way to relieve symptoms and regain mobility, though — usually with a total knee replacement. That’s especially true if you have inflammation and swelling that won’t go away, feel pain even while resting or can’t climb stairs, get in and out of chairs or walk more than a few blocks.

During a total knee replacement, Dr. Barrett carefully trims bone and loose cartilage from the ends of the thighbone (femur) and the shinbone (tibia). She then attaches metal replacement parts and inserts a special plastic spacer between them to restore glide. In some cases, the knee bone (patella) is also resurfaced with surgical-grade plastic.

Dr. Barrett only uses replacement parts with a proven track record, with the implants lasting at least 10 to 15 years for more than 90 percent of patients.

Digital X-rays taken before surgery and digital templates mean better accuracy in sizing the parts patients need. While most do well with off-the-shelf models, Dr. Barrett says, the hospital offers custom jigs to guide surgeries and custom implants when needed.

Experienced anesthesiologists and new ways to deliver pain medications mean patients need fewer narcotics after surgery, and Milford Regional has a specially designed operating room for joints, helping patients avoid infections. The hospital also offers an hour-long session twice a month where prospective patients can learn more about knee replacements. I think it helps them to know what’s going to happen, so they know what to expect,” Dr. Barrett says. That includes several days of recovery in the hospital, the importance of committing to rehab after surgery and the need to protect the replaced joint by keeping weight in check and sticking to low-impact exercise.

Those who follow the advice, Dr. Barrett says, almost always see an improvement in comfort and function — an outcome experienced by both Donna and Bill. “Everything was wonderful,” Donna says of her 2011 surgery, crediting both Dr. Barrett skills and the kindliness and helpfulness of the hospital staff. “Everything went exactly as I thought it would go. I just can’t say enough good things about them.”

Bill, whose knee replacement took place earlier this year, agrees: “Everything went bing, bing, bing, just the way Donna said.” When he arrived at Milford Regional, he said he felt more welcomed than at other hospitals, places where he did not get the “warm and fuzzies.”

Scheduling an appointment was also easy, he says, and when he arrived for surgery, he sensed the sincerity from the staff whenever they asked if they could do anything to make him more comfortable. “Their people are just outstanding,” he says. “They make you feel great in a situation where you’re kind of scared.”

Dr. Barrett credits the Milford Regional team with working hard to give patients personal attention and care. “Everyone at Milford wants our patients to have a good experience,” she notes. “You’re not a number.”

Read more about Susan Barrett, MD, MPH

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