Study by University of Delaware Professor of Physical Therapy Proves Putting Surgery on Hold Affects Quality of Life
ALEXANDRIA, VA, February 4, 2008 — A new study out of the
University of Delaware (UD) indicates that women may wait too long to
pursue knee-replacement surgery. "By postponing surgery until they can
no longer stand the pain, these women also may risk putting their
mobility-and their quality of life-on hold indefinitely," says Lynn
Snyder-Mackler, PT, ScD, SCS, ATC, FAPTA, distinguished alumni professor
in UD's Department of Physical Therapy and a certified sports physical
therapist and athletic trainer.
"Physicians typically tell patients to wait to have knee replacements
until they just can't stand the pain any longer," Snyder-Mackler said.
"Our research shows that may be bad advice-and worse for women than it
is for men-because your level of function going into surgery generally
dictates your level of function after surgery," she noted.
Snyder-Mackler led the research team for the study, which was funded
by a $1,125,000 million grant from the National Institutes of Health
(NIH). At the University's Physical Therapy Clinic, 229 candidates for
total knee replacements, including 95 men and 126 women with
osteoarthritis, were evaluated and compared with 44 healthy men and
women who matched them in gender, age, and body-mass index. Each subject
took part in a series of standard physical tests such as stair climbing
and the distance covered in a 6-minute walk.
The strength of the participants' quadriceps-the major thigh muscle
that extends and straightens the knee-and range of motion of the knee
also were assessed at the clinic. While the men generally were stronger
and had more knee function than the women, the test results showed a
much greater degree of physical disability in the female
knee-replacement candidates compared with the male knee replacement
"Both the men and women had osteoarthritis, but the women were at
much more advanced stage than the men with the disease," Snyder-Mackler
said. "Despite both groups having painful, end-stage osteoarthritis,
where the cushion of cartilage padding the knee bones has completely
deteriorated and you basically have bone hitting against bone, the women
demonstrated a marked decrease in function compared with the men."
Snyder-Mackler observes that there may be a number of reasons why
women may wait so long before pursuing surgery. She suggests that
perhaps women can bear pain better than men, or a woman's world
increasingly revolves around the home as she ages, or it could be that
women are just trying to follow doctor's orders. "Osteoarthritis of the
knee is the most common cause of disability among Americans. It's a
disease of age that affects more women than men on a 60-40 basis,"
Snyder-Mackler said. "Physicians generally have advised patients to wait
as long as they can before pursuing knee replacements, with the thinking
that it is a once-in-a-lifetime surgery that should last an average of
Snyder-Mackler concludes that women need to become more educated
about the risks and benefits of knee-replacement surgery, and heed the
warning signs of serious problems. "When you feel profound buckling and
weakness in your knee when climbing stairs, that is a tell-tale sign of
a major problem," she notes. "You end up compensating, say, by avoiding
the stairs. As a result, you become sedentary, and that's not good for
your health. Earlier intervention can help preserve your mobility and
quality of life."
Snyder-Mackler notes that, if possible, once patients have been
diagnosed with osteoarthritis, they should try to remain fit and keep
muscles strong through exercise, which will help post-surgery. "The
candidates for knee-replacement surgery are not going to get their new
knees and start running marathons," she notes. "Their goal-as well as
the goal of their physical therapist-is simply to resume normal, daily
functions without any pain or discomfort."
Physical therapists are health care professionals who diagnose and
manage individuals of all ages who have medical problems or other
health-related conditions that limit their abilities to move and perform
functional activities in their daily lives. Physical therapists examine
each individual and develop a plan of care using treatment techniques to
promote the ability to move, reduce pain, restore function, and prevent
disability. Physical therapists also work with individuals to prevent
the loss of mobility by developing fitness- and wellness-oriented
programs for healthier and more active lifestyles.
The American Physical Therapy Association (www.apta.org) is a
national organization representing physical therapists, physical
therapist assistants, and students nationwide. Its goal is to foster
advancements in physical therapist education, practice, and research.
Consumers can access "Find a PT" to find a physical therapist in their
area, as well as physical therapy news and information at www.moveforwardpt.com.