JOINT UNDERTAKINGS LONGER LASTING KNEE AND HIP REPLACEMENTS AND STREAMLINED OPERATIONS IMPROVE OPTIONS FOR OSTEOARTHRITIS SUFFERERS.

Byline: Mariko Thompson Staff Writer

When 75-year-old William Ruddiman saw a woman fall off the treadmill at the gym, the accident served as a wake-up call. The Encino resident had been hobbled by an unstable right knee. Knowing that a fall could be catastrophic at his age, Ruddiman opted for knee replacement surgery.

``This is pretty major stuff,'' said Ruddiman, his knee swollen and the skin stapled shut 10 days after undergoing surgery at Encino Tarzana Regional Medical Center. ``I'd known for quite a while that I would have to do it, not because of the pain but because of the instability.''

Every year, an estimated 435,000 Americans replace a knee or hip joint with an implant. The main culprit is age, from cartilage wearing down until bone hits bone. The breakdown of cartilage, a condition known as osteoarthritis, is the most common form of arthritis and affects about 20.7 million Americans.

Though total joint replacement is a major undertaking, people are never too old to do the surgery, said Dr. Gregg Sobeck, an orthopedic surgeon at Sherman Oaks Hospital.

``I see people at age 60 who are in worse health than some 90-year- olds,'' Sobeck said. ``There's no age cut-off. If you're in pain, there's no reason to stay in that pain. It can make the next 15 years a lot better.''

In the past, orthopedic surgeons worried more about performing the surgery on younger patients, not older patients. Concerned that the wear on the implant would require a second replacement surgery, they had reservations about doing the procedure on patients under 60.

``If you wear it out, it's not simple to replace,'' Sobeck said. ``It's not like changing a tire on a car. It's a more difficult surgery and recovery. Now that the parts last longer, we're more likely to do (joint replacement surgery) in younger patients.''

People who suffer from osteoarthritis often can treat the condition - or at least delay surgery - through more conservative methods. Over-the- counter or prescription medications, such as Tylenol or Celebrex, may control the pain. Other methods include physical therapy, activity modification, steroid injections and lubricant injections.

According to the American Academy of Orthopaedic Surgeons, the nutritional supplement glucosamine appears to reduce pain, but long-term research has not yet been done on whether the substance slows degeneration of cartilage. Patients also might undergo arthroscopic surgery, in which surgeons use a miniature camera to view the joint and clear out debris from degenerated cartilage.

When chronic pain becomes unbearable and other methods fail, it's time to consider total joint replacement surgery. The procedure is moving toward smaller incisions and quicker recovery times. For both hip and knee, the average hospital stay is about three or four days, though the rehabilitation process lasts for several weeks or months.

With total knee replacement, the diseased cartilage affects three surfaces: the thighbone, the shinbone and the kneecap. In the hip area, a total replacement means both ball and socket. Hip fractures, which are common in the elderly, typically require a partial replacement involving a ball implant, said Dr. Richard Kertzner, an orthopedic surgeon at Kaiser Permanente in Woodland Hills.

For total hip replacement, some surgeons are now touting a minimally invasive technique. Orthopedic surgeons say the standard incision ranges anywhere from eight to 16 inches. The less invasive technique reduces the incision to less than four inches, said Dr. Ramin Ganjianpour, an orthopedic surgeon at Providence Holy Cross Medical Center in Mission Hills.

``As a result of cutting less, the patient has less pain and recuperates faster,'' Ganjianpour said.

But Kertzner cautioned that there are still questions about the minimally invasive procedure.

``We don't have the long-term data,'' he said. ``If the new technique is done and is good for a year or two, but fails after five years, we haven't done our patients a service. There needs to be long-term follow up.''

Surgeons say they can't predict how long a joint implant will last. Longevity depends on such factors as weight and activity level. An 80- year-old woman who weighs 100 pounds may get 20 years out of a joint implant, while a 50-year-old man who weighs 300 pounds may wear out the replacement sooner, Sobeck said.

Assuming there are no complications with surgery or rehabilitation, patients should be able to resume their hobbies and activities without pain.

``I have a little old lady who loves to dance and is in her 80s,'' Sobeck said. ``She's got two new knees and dances every night.''

Doris Jacobson, 81, hopes she'll be dancing soon. Jacobson broke her hip in mid-September and is recovering from total replacement surgery at Encino Tarzana Regional Medical Center. The Woodland Hills resident caught her foot on the leg of a bench at her gym and fell.

``I came down so hard, I knew that I broke it,'' Jacobson said. ``You can't imagine, you feel so inadequate. All of the sudden, you can't even get in and out of bed.''

Patients recovering from hip and knee replacement go through physical therapy as well as occupational therapy, which teaches them how to adapt to day-to-day tasks such as showering, dressing and cooking.

Patients with hip implants have to be cautious in their movements during the healing process. They aren't supposed to cross their legs, bend at the waist beyond a 90 degree angle, or stand pigeon-toed.

Jacobson has improved to the point where she moves well with the aid of a walker. At a recent physical therapy session, she let go of the walker and gripped the rails of a wooden bridge. With physical therapy assistant Sylvia Pena holding her waist from behind, Jacobson climbed two steps, walked across the bridge and descended.

With knee replacement, physical therapy works on the range of motion. Knee patient Ruddiman attended his third physical therapy session just 10 days after his surgery. He's also supposed to do exercises in his hospital room to keep the joint moving. Otherwise the knee will get tight, said Michelle Blanchard, a physical therapist at Encino Tarzana Regional Medical Center.

At the end of their session, Blanchard asked Ruddiman to sit up and bend his knee. She measured his range of motion with a plastic wheel.

``The strength is really coming along,'' she said.

``It was worked hard this morning,'' Ruddiman said with a grimace.

Blanchard is pleased. At this rate, he'll be back on the treadmill in no time.

Before you do it

More than 435,000 Americans undergo hip or knee replacement surgery each year. For many, the cause is osteoarthritis, a condition in which cartilage in the joints breaks down. The following resources provide additional information on total hip or knee replacement surgery, and osteoarthritis:

Arthritis Foundation Southern California chapter, [phone], www.arthritis.org

American Academy of Orthopaedic Surgeons, [phone], www.aaos.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases, www.niams.nih.gov/hi/index.htm

- M.T.

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3 photos, box

Photo:

(1 -- cover -- color) Doris Jacobson, 81, who broke her hip last month and underwent replacement surgery, ascends a wooden bridge with the help of physical therapist Sylvia Pena at Encino Tarzana Regional Medical Center.

(2) William Ruddiman, 75, recovering from knee-replacement surgery, works with physical therapist Michelle Blanchard at Encino Tarzana Regional Medical Center.

(3) Shari Sanaseri puts her new knee through its paces using a tool to slip into her socks as occupational therapist Julie Valle looks on at Encino Tarzana.

John McCoy/Staff Photographer

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Before you do it (see text)