Elective knee surgery: what to know before you have it

Menino’s knees have given him trouble time and time again. In 2008, he had arthroscopic surgery on his right knee to repair torn cartilage from a previous injury. And last year, he severed a tendon that connects his thigh muscles to the top of his left kneecap while walking up a flight of stairs. For that injury, he chose to see a physical therapist rather than have surgery.

That leads me to wonder: If you’ve got knee pain, how do you decide whether to have surgery or wait it out, hoping the pain will go away with physical therapy and perhaps a cortisone shot to stop the inflammation?

I pose this question to Dr. Andrew Freiberg, vice chair of the department of orthopedic surgery at Massachusetts General. He tells me the answer isn’t simple.

“It depends on what’s wrong,’’ he says. “Reasons for knee surgery often involve a tear in the meniscus [the C-shaped disc that cushions the knee], a ligament problem, or severe arthritis in the joint warranting a knee replacement.’’

Whether you opt for surgery or less invasive measures depends on how much pain you have and how much loss of function in terms of, say, climbing stairs, getting into and out of your car, and walking from place to place. “The goal of surgery is to improve function if there’s a deficit and to improve pain,’’ says Freiberg, “but it really depends on getting an accurate diagnosis.’’

If you’re experiencing chronic knee pain, the first thing you should do is get a physical exam from your primary care physician and a set of X-rays. “We don’t start with an MRI,’’ Freiberg says. “That’s a common misconception many patients have.’’

If the X-ray shows severe arthritis, a knee replacement could be an option. Early-stage arthritis usually isn’t treated with surgery. Often, though, the X-ray may show nothing because it won’t show a cartilage tear, Freiberg says. If that’s the case, a month of physical therapy is typically the first line of treatment to see if that improves pain. An MRI may then be warranted if pain doesn’t improve from the therapy.

If you opt for surgery, finding a good orthopedic surgeon is, of course, key. You can ask your primary care doctor for a referral and once you meet with the surgeon, ask about the surgery’s success rate. For joint replacements, Freiberg says, success rates are usually about 95 to 98 percent.

You can also tell a good surgeon by how long it takes to book your elective procedure. Top ones usually have three- or four-month waiting lists — long enough for you to see whether the pain will resolve on its own.

Recuperation time from surgery varies. The mayor was told six weeks, but some people recover faster or slower depending on the type of surgery. Repairing a torn meniscus, for example, requires longer recuperation than removing the meniscus altogether, since the repaired tissue needs time to heal, Freiberg explains.

While anyone north of 50 can, like the mayor, develop knee problems from simple wear and tear on the aging joint, certain folks are more susceptible. Being overweight is a major risk factor, says Freiberg. One study found that having a body mass index slightly above the healthy range gives you a three times greater risk of having a cartilage tear in your knee than someone who’s not overweight. Those who are obese have an even higher risk. People with Crohn’s disease, like Menino, are also at higher risk of having joint problems.

DEBORAH KOTZ

Still time for a flu shot

If you get vaccinated this week, you should have good immunity before flu really gets underway. DeMaria says it takes about two weeks after you get vaccinated for your immune system to be fully revved up — and perhaps even less time if you’ve been vaccinated in the past.

Pharmacies and clinics are still offering flu shots on a walk-in basis for $20 to $30 a shot if your insurance doesn’t cover it. Find out where to get one at flu.masspro.org/clinic. D.K.

Have heart disease? Maybe dad's diet is to blame.

At least father mice: Scientists at the University of Massachusetts Medical School fed male mice two diets before allowing them to impregnate females, and found that those who were fed a poor, low-protein diet were likelier to sire babies that had genes responsible for churning out high amounts of cholesterol — a major factor in heart disease risk — compared to those who ate more protein.

“Knowing what your parents were doing before you were conceived is turning out to be important in determining what disease risk factors you may be carrying,’’ said Dr. Oliver Rando, an associate professor of biochemistry and molecular pharmacology and principal investigator for the study. D.K.

Squeeze in a workout -- on the airplane

Core strengtheners. Sit up tall and lift one foot three to six inches off the floor. Hold for five to 10 seconds or up to 30 seconds if possible. Repeat on the other foot for a total of 15 repetitions.

Triceps builders. Grab both armrests and push up so you’re lifting your rear end off the seat. Hover over your seat for up to 20 seconds before coming back down. Breathe normally but hold your abdominal muscles in to work your core. Repeat 10 times.

Improve circulation. Do wrist and ankle circles by rotating each wrist and then each ankle in a circular motion. Do eight to 12 circles for each wrist and each ankle, then reverse the direction of the circles for another set of reps. D.K.