Knee Replacements: Today's Diktat, Tomorrow's Disappointment

There are three things in life you shouldn’t rush into – marriage, litigation and knee replacement operations. A few weeks ago we posted a feature about arthritic knees, hoping to dispel the myth that the malaise was caused by fair ‘wear and tear’. We’re forced to return to this theme today, as an agonised response to a widely publicised statement by an English orthopaedic surgeon. He’s devised, and now trying to sell, a new

prosthesis which he hopes will be popular with middle-aged fitness buffs who, he claims, are damaging their knees by their obsession for keep fit activities, like tennis, Zumba dancing and workouts in the gym. At present the NHS carries out about 70,000 knee replacement operations a year. Our knife happy surgeon expects this figure will rise by twenty per cent in the next ten years, a prediction based on his assumption that there’ll be an increased demand for joint replacements by people in their fifties and sixties. This could well be a self-fulfilling prophesy, if cut and paste surgery is offered as an easy option for knee problems. What’s needed in many cases is not surgery, but physical rehabilitation. Arthritis is undoubtedly linked with injury, but never with normal joint use. Nobody could have taxed their knees more than Fred Astaire, who was still able to perform song and dance routines with Gene Kelly in his late seventies. (When he was

78 he broke his left wrist using his son’s skate board.)

Our knees complain most when they’re under-used. They’re at their stiffest after a long car journey, or in the morning after a night in bed. That’s because they need movement to nourish the smooth hyaline cartilage that lines and protects their joint surfaces. That I explained in my first book, Hands for Healing, written nearly fifty years ago under the pen name ‘David Devon’. In the book I gave details of research trials which had shown that healthy joints have an incredible ability to withstand everyday stresses and strains without showing any signs of wear. Experiments had revealed that animal joints could be fixed in a stand, loaded with weights and then rapidly moved backwards and forwards to stimulate the effect of weeks of normal use. Even after twenty-four hours of this gruelling test, the joints showed no signs of wear. But when they were compressed in a clamp, and prevented from moving, signs of degeneration soon occurred. Since these experimentally-produced changes were identical with those found in osteo-arthritic joints, the researchers wondered whether it was that lack of movement, rather than excessive use, which was the more potent cause of joint deterioration.’ This conjecture was confirmed when experiments were carried out in Sweden, involving the injection of dyes into the network of looped blood vessels found in the bony ends of joints like the hip and knee. The articular surface of these bones is covered with smooth hyaline cartilage, which acts rather like a sponge. When the joints were at rest, there was no movement of dye from bone to cartilage. But the moment they were flexed there was an immediate diffusion of nutrient fluid into the cartilage. There are in fact three simple ways of improving the health of creaky knees, without the use of surgery or pain killing drugs. The first is to avoid carrying excess body weight. The second, to wear flat, flexible shoes, so that the feet can adjust to ground irregularities and protect the knees from unwelcome jerks and twists. And the third, to get regular physical exercise, in the sure knowledge that joints are far more likely to rust away than wear away. The gentlest way to start this regime is with aqua-aerobics. Find a local swimming pool, where you can use the buoyancy and resistance of the water to give your limbs a healthy work-out without placing strain on your joints. Devotees of yoga often assert that ‘Movement is Life.’ But for the sake of our joints, we should also remember that ‘Life is movement’.

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