Orthopedic Surgery

On top of the world

Knee replacement patient Fran Wilson strolling along the top
of the Great Wall

Last year, when she was 66 years old, Elkridge, Maryland, resident Fran Wilson crossed a big item off of her bucket list. She traveled to China to walk the Great Wall, and made her way to Tibet to climb the more than 700 steps of the Dalai Lama’s ancient Potala Palace, a 17th-century behemoth perched on top of the Red Mountain. This trip would have been quite a feat for anyone; what made it even more amazing in Wilson’s case was that she had just undergone a total replacement on her right knee one year earlier.

Before she had her surgery, Wilson was in far too much pain to entertain the thought of spending two and a half weeks climbing, standing and exploring on the other side of the world. She had a hard enough time making a shopping trip to the mall, or even getting something out of the shed in her backyard. A usually social and outgoing person, she found herself declining invitations from friends and family because her knee hurt too much to leave the house.

Taking the First Step

Surgery was definitely not on the top of Wilson’s list when she first began seeing Carl Johnson, M.D., a Johns Hopkins orthopaedic surgeon. “I was afraid to do it,” Wilson says. She worked with Dr. Johnson for years on other ways to help alleviate her knee pain, including cortisone injections. “I at least wanted to delay surgery until after I retired,” she says.

Wilson had a lot in common with most of the patients that Dr. Johnson sees in his practice. Specializing in arthritic knee treatment and knee reconstructive surgery, Dr. Johnson sees mostly patients over the age of 50 who are experiencing knee pain and stiffness as the result of arthritis. Arthritis is a disease that creates wear of a joint. As you age, the smooth cartilage that lines the end of your knee bones begins to wear. For many people with arthritis, this wear and tear happens much more quickly, until bone begins to rub directly on other bone in the knee, causing pain and stiffness.

Dr. Johnson’s job is to find a way to put an end to that pain, and help patients return to their normal lives. “Not everyone with arthritis needs surgery,” he says. Dr. Johnson works with patients to exhaust all other options to relieve pain before knee replacement is considered. Wearing soft-soled shoes, losing weight, modifying your exercise routine, taking supplements or trying injections can often ease pain enough to delay or avoid surgery.

Choosing Knee Replacement

“Knee replacement is one of those life choices that you only want to make once,” says Dr. Johnson. “You want to do it right the first time.” Patients like Wilson usually decide that it is time for knee replacement surgery when the pain has become severe enough that they are no longer able to live the lives they want. “In most cases, the pain relief after surgery is tremendous,” says Dr. Johnson. In a knee replacement surgery, the doctor replaces the worn bone with metal and plastic pieces that are carefully constructed to mimic an actual human knee as closely as possible.

Dr. Johnson is just one of the physicians who makes up the “Joint Effort” orthopaedic team at Johns Hopkins Bayview. “We all work together closely and communicate to standardize each patient’s care,” says Dr. Johnson. Each patient is looked at as an individual, with the understanding that no two patients’ needs are the same. The orthopaedic team evaluates a patient’s history, physical exam, X-rays and other test results, and lifestyle to determine if knee replacement surgery is the right option for them. The physicians at Johns Hopkins Bayview perform more than 360 knee replacement surgeries a year, so they are well-equipped with the knowledge and tools they need for successful outcomes.

“Our joint replacement program is set apart from others by our breadth of experience for knee problems,” says Simon Mears, M.D., chair of the Department of Orthopaedic Surgery at Johns Hopkins Bayview. “Our physicians are experts at surgeries to try to prevent knee replacements, including osteotomies, cartilage repair surgery and partial replacement. We also have experts in knee replacement itself. This extent of specialization helps us take care of every patient with knee problems ranging from the simple to the very complex.”

Life After Surgery

“I didn’t realize how limited my world had become because of my knee pain until after the surgery,” says Wilson, who made the final decision to have joint replacement surgery in 2009, after she had retired, and after the pain had become greater than she could manage. “My life has reopened; I have a whole new me,” she says.
Once afraid to walk or stand for more than a couple minutes, Wilson now goes to the gym three days a week. She says that the surgery and rehabilitation were challenging and painful at times, but completely worth it. “Dr. Johnson let me know that I could do it,” she says. “And now I’m back to 100 percent.”

Wilson’s results are typical of the patients he treats, says Dr. Johnson. After a three-day hospital stay, patients usually return home, and receive outpatient rehabilitation therapy for two or three months. Dr. Johnson encourages his patients to get out and about as soon as possible after surgery. “The more they do for themselves, the faster they are able to recover,” he says. After three months, most patients are able to return to their normal activities. Dr. Johnson works closely with patients before surgery to manage their post-operative expectations. Patients will experience some stiffness in the joint after total knee replacement, but this gradually improves over time.

Just one year after her surgery, Wilson was standing on top of the world—more precisely, on top of the Great Wall of China. And this 67-yearold world traveler says her adventures are just beginning; she wants to plan a trip to Greece in the near future. “After my surgery, I can do it all,” she says. “And I want to.”