Four Joint Replacements, One Resolute Patient

Rheumatoid arthritis might have gotten the best of Susan’s joints, but it couldn’t touch her attitude

Susan, left, with her sister

An MRI showed a torn meniscus in Susan’s knee, so her doctor recommended meniscus surgery. Perhaps it would help with the knee pain she’d been experiencing for a year. Neighbors and others had recommended Dr. Douglas Lange of Muir Orthopaedic Specialists for the surgery. Susan, a Walnut Creek resident in her early 60s who works as an attorney in San Francisco, saw him just after Christmas 2010.

“He told me both my knees and my hip needed to be replaced. I didn’t believe him,” recalls Susan. “My blood pressure shot up like, Whoa! I came in thinking I was getting a meniscectomy. It was a lot to deal with.”

But so was the pain and discomfort she was constantly experiencing. She had been diagnosed with rheumatoid arthritis in 2010 before her appointment with Dr. Lange and had been on medication for that. Susan wanted to wait until retirement to have any major work done, or the relatively minor meniscectomy, for that matter.

“I thought I wasn’t ready to do this,” says Susan, concerned that the operation and recovery from joint replacement would take too long. “But when Dr. Lange and I were talking, I told him I couldn’t put my socks on—I had to use a sock helper. He helped me realize how much I was putting up with.”

She discussed it with people in her office and with her sister. The two are very close and travel a lot together.

“One of my big problems was not being able to travel,” says Susan. “We haven’t been able to travel much, and up until 2010, we went to Europe every year. But we didn’t do that in 2011 or 2012.”

Ultimately, Susan decided that surgery was what she would have to do.

“I was worried that—and I joke about it now—somehow the company wouldn’t survive without me. But they did,” she says with a laugh. “It’s a major corporation, they didn’t falter while I was out, and the stock did even better while I was out. But in your mind, you worry about things like that. I shouldn’t have. I’m just the kind of person who thinks like that.”

Emotionally prepared for joint replacement

She decided to put her Irish stubbornness to the task of having her hip replaced and recovering from it in better shape. Barely walking and needing help to get into the hospital, she had her hip replaced in 2011.

Susan lives alone and stayed at her sister’s house after surgery. Her sister had taken out rugs and rearranged things in the house that could be a problem for Susan as she was recuperating with limited mobility. Susan had made the same preparations at her home.

“My sister came to the hospital every day and we would talk. She also talked to Dr. Lange after the surgery. She’s a retired executive and is very good at taking notes,” says Susan. “She would tell me what Dr. Lange told her when I was unconscious or groggy.”

The help Susan’s sister gave her was extremely important for her recovery. Having a loved one or family member participate fully in the joint replacement helps the patient maintain a better attitude and to respond well to the operation and rehabilitation. Dr. Lange says that speaking to the doctor and relaying his or her information to the patient is a great service one can provide to a joint replacement patient.

Susan was out of work for eight weeks. She came out of her surgery much better than she went in—thanks to her determination and her sister’s and Dr. Lange’s care. Her new right hip was working much better than the old joint. But now her right knee was getting worse. Even after the meniscectomy, it was deteriorating from the rheumatoid arthritis.

But a second joint replacement in one year? Dr. Lange helped her arrive at the decision, again preparing her emotionally for what to expect. As with her first joint replacement, he encouraged her to attend joint replacement classes at the hospital and educate herself online about the procedure. Which she did, finding comfort in knowing what to expect.

“Dr. Lange is passionate about what he does, and he takes the time with each patient to answer all their questions,” says Susan. “He never talked down to me, and he explained things to me how I would understand it. A couple of times he drew pictures on the paper on the examining table of what my joints looked like and how bad they are. I think I still have those!”

Again, again and again

Susan Susan’s right knee was replaced on the Monday before Thanksgiving, 2011. On Thanksgiving Day, Dr. Lange came to see her.

“He put his Thanksgiving turkey in to be brined and came over to the hospital to release me,” says Susan. “Then went back to work on his turkey. Isn’t that great? Dr. Lange has one of those green egg grills and he is king of the BBQ. His family loved his turkey.”

And Susan was well pleased with her new knee. But rheumatoid arthritis was working on her left knee fast, with x-rays showing deterioration and her pain requiring injections. Since the first two joint replacements had gone so well, Susan was even more receptive to taking on another one. So in April of 2012, Dr. Lange replaced her left knee. And how did it go?

“Oh my gosh, each time I was so happy after having the replacement. Dr. Lange had told me, ‘You will know when you need it done.’ And I did,” says Susan.

About a year and a half later, she thought she knew again. Her left knee, which had already been replaced, was getting worse. Dr. Lange initially thought it was the source of her pain. But he wasn’t certain, so he did more tests, finally determining that it wasn’t her new knee, but her left hip that was the source of her pain.

So five days before a scheduled trip to Europe with her sister, Susan learned she would need to have her left hip replaced. She decided that the trip must go on and that her sightseeing would just have to be encumbered somewhat by using a walker. About a month after her return, she had the surgery.

Of course, after four joint replacements in two years, Susan was something of a pro at recovery and rehab. Rule #1 was to always obey the doctor’s orders.

With the hip, her rehabilitation was less physical therapy and more walking. And she had to take a lot of precautions in the first six weeks. For the last hip replacement, Dr. Lange prescribed home health therapy, and she and the therapist would go walking. First with a walker, transitioning to a cane, then on her own and taking stairs in her home.

With her knees, it was more regular physical therapy. A continuous motion device at first to keep the knee from freezing up, then an exercise bicycle and formal physical therapy. It was a lot of work, to be sure.

“My quality of life is much better now. I basically now have no pain,” she says. “I’d be crippled but for modern technology and modern medicine.”

Though she never completely stopped traveling, she’s now making trips in California with her sister. And a European trip is on the horizon, perhaps later this year or in 2015—without a walker.

While her Irish stubbornness may have helped her pull through the rigors of four joint replacements, her positive attitude was an even greater attribute.

“I consider myself lucky. My rheumatologist’s office in Walnut Creek is on the same floor where people who don’t have legs get prosthetics,” says Susan. “It just makes you think: How can I complain about a little pain in my knee when I’ve got a knee?