Eddie's new knees
Knee replacement surgery gives Higbee man a chance to walk without pain

His legs wrapped in iodine-impregnated film, Eddie Edwards undergoes double knee replacement at Columbia Regional Hospital. Hockman uses a number of specially designed tools for knee surgery. His procedure is less invasive than knee replacement surgeries done in the past few years. The entire operation is done through a 4- to 5-inch incision. He also cuts less muscle tissue which leads to speedier recovery by his patients. Eddie was able to walk again the day after his surgery.

Last fall Eddie Edwards did something he truly enjoys. He loaded his horses in a trailer and headed to Eminence for the Cross Country Trail Ride. Unfortunately for Eddie, a member of Howard Electric Cooperative who lives near Higbee, the experience was not pleasant this time.

Severe arthritis in his knees left him unable to walk more than a few steps and mounting a horse was sheer agony. “Usually I walk to the mess hall,” Eddie says. “This year I drove.”

For 10 years the pain in Eddie’s knees had gotten steadily worse. Doctors advised him to wait until the pain became too great to tolerate. In October Eddie, 62, was at that point.

“The pain was 40 and the scale only goes to 10,” he says. Getting up hurt. Sitting down hurt. He felt pain with every step. The time had come to seek some relief.

Eddie’s wife, Paula, works as a nurse in the rehab unit at Columbia Regional Hospital. Over the years she had seen a number of patients undergo knee replacement surgery. She learned of a new technique performed by Dr. David Hockman, a surgeon with the Columbia Orthopaedic Group.

“So many of his patients do so well,” Paula says. “They get moving so quick. So that’s where we headed.”

Doctors have been replacing knees for about 30 years. Nearly 250,000 Americans get new knees each year, with the number increasing as the population ages. But in the past knee surgery involved huge incisions and cut muscles that left patients with a long, painful recovery.

Eddie waits patiently for the surgery to begin. If anyone could look forward to an operation it was Eddie, whose knees caused him tremendous pain.

Hockman began doing the new procedure in August 2003. He was told to expect about 100 patients his first year. Instead he had more than 300 in his first full year of practice. His patients have come from all over Missouri and as far away as Arizona.

“They don’t have to have this done,” he says. “They can do less activities or use a walker. But that’s not a healthy option.”

Hockman uses a new technique called “minimally invasive knee replacement.” The procedure is done through an incision that is 4 to 5 inches long using miniature tools and high-tech replacement joints.

“The old way was to cut, twist and stretch,” says. Hockman. “People re-covered but it took them a long time.”

He says doctors used to cut all the way through the patient’s quadriceps tendon, which surrounds and supports the knee joint. Then they would rotate the knee cap out of the way to get at the joint surface that needs to be replaced.The new technique spares most of the quadriceps. The small incision is moved around when the doctor needs access to a different part of the knee. New tools, including guides resembling woodworking jigs, let the surgeon cut away damaged knee parts and drill holes to attach new material to the leg bones.

Dr. David Hockman, a surgeon with the Columbia Orthopaedic Group, holds a model of the replacement knee.

In October Eddie made an appointment with Hockman, who cleared him to have both knee joints replaced.

Eddie’s problem was caused by bone spurs and worn cartilage that allowed his bones to rub together. Because of the pain Eddie quit exercising. This caused him to gain weight, which only made the problem worse.

He says the rigors of working on the railroad, jumping to the ground and grabbing on to moving train cars, took its toll on his body.

Over the years doctors tried just about every form of treatment to ease his pain. He had cortisone injections, used arthritis medications and even had arthroscopic surgery. Knee replacement seemed to be his best option, but doctors wanted him to wait as long as possible because the replacement joints also wear out.

On a cold, dreary morning in January, Eddie checked into Columbia Regional Hospital and prepared for surgery. Eddie would have both knees replaced during the surgery.

Paula kissed him goodbye and nurses wheeled him into a brightly lit operating room.While Hockman and his team listened to songs like “Old Time Rock and Roll” and “Don’t Worry, Be Happy” on the operating room stereo, Eddie blissfully snored through the surgery.

In an X-ray of Eddie Edward’s knee the new material installed by Dr. David Hockman stands out from the gray bone. Com-posed of oxinium, polyethylene and a titanium base, the new knee material is cemented onto the bone. The doctor compares the procedure to a dentist putting crowns on teeth.

The procedure took most of the morning, one to two hours per knee. Hockman likens it to a dentist resurfacing a diseased tooth with a crown. The damaged pieces of bone, pockmarked like the skin of an orange, were sawn away. Holes were drilled into the bone using a precision guide that wrapped around the knee bones.

Then a replacement joint was glued into the holes. In the past (and still today) cobalt chrome was used for the three knee replacement parts. Eddie’s new knees are made from oxinium, a new material made by allowing oxygen to absorb into zirconium metal. In the process its surface changes from a metal to a ceramic combining the best advantages of both materials.

By 1 p.m. Eddie was out of the operating room. He could walk that same day but Hockman prefers to let patients recover fully so they don’t lose their balance and fall. The pain is intense, much worse than Eddie expected.

“I had no idea what I was getting into pain-wise,” Eddie admits a few days after surgery. “Most operations I’ve had I was back up right away. I’m a man, man. But with this one it didn’t work that way.”

His first steps with the new knees were baby ones, just four steps to a chair with a lot of assistance. A few days later, however, the pain eased enough that he was able to walk by himself using a walker.

Six days after surgery, Eddie still feels pain but can move with the aid of a walker. While the road back will be a long one, Eddie believes his new knees will improve his quality of life.

The walker is standard issue for a month to six weeks. But most patients make their six-week checkup without it, Hockman says.

In time Eddie will be able to return to most of the activities he once did. “There’s a lot of dos and don’ts and the first thing is, ‘don’t take a chance,’ ” Eddie says.

High impact activities like running or tennis are off-limits for life. He will have to avoid rough ground and slippery surfaces. But studies show with proper care the knee has an 85 percent chance of lasting 15 to 20 years.

Still the new knee won’t be the same as the one Eddie was born with. “What God gives you is a lot better than anything man can make,” Hockman says. “This will take care of the pain but there will be some limitations. It won’t pivot and he will be limited to low-impact activities.”

As the pain gets better Eddie is looking forward to returning to his old activities. “This is going to make a difference,” he says of the surgery.

“This doctor, he told me it’s going to hurt. But if I keep doing the exercises, it’s going to get better.”

In the future Hockman says gene therapy might replace the surgery he now performs. He says if the technique can be perfected patients will receive injections of their own genes that will instruct the knee to repair itself.

“I’ll be an antique then,” Hockman says.

For more information about knee replacement surgery call (573) 876-8662 or on the Internet visit www.ortho.smith-nephew.com/us.