By CINDY LADAGE
Illinois Correspondent

SPRINGFIELD, Ill. — Bum knees – they come with the territory of farming.

“Farmers are always jumping on and off of equipment and walking over uneven fields, this wears on the knee,” said Dr. Daniel Adair, M.D.

Adair is a board-certified orthopedic surgeon whom many central Illinois farmers end up consulting about knee surgery.

“Everyone needs to go through the conservative care first,” he warned. “The most important reason for surgery is pain interfering with your lifestyle, limitations of activity due to pain.”

There are two main reasons a patient may need knee replacement surgery. The first, which affects many farmers, is the simple wear and tear of the knee, which may eventually result in degenerative arthritis, causing progressive loss of the cartilage and joint.

“With degenerative arthritis, there is nothing we can do about it. We can’t undo it or make it better. We can’t regenerate or rebuild cartilage at this time. That is at least 10 to 20 years away,” Adair explained.

The second reason? “Micro-trauma is created through repetitive actions such as walking or running,” he said, “while a macro-trauma comes from more traumatic injury such as blowing out the knee. Factors such as weight and genetics also influence the degree of damage from degenerative arthritis.”

For farmers looking at knee replacements, there are two options: partial knee replacement or the more common total knee replacement.

“Total knee replacement has good results. It’s a one-stop shop and has nice predictable results,” Adair said. “Partial knee replacements are good under the right circumstances.”

Once surgery has been scheduled, he advises recipients to be in good physical shape and at an optimal weight. “The better condition they are physically in, the better they will do, post-operative. This will make for a much nicer and safer recovery.”
Physical therapist John Gee, who works on many knee replacements, also suggested prior to surgery to “get into a pool. It lets you exercise with minimal weight-bearing.”

Another way that he mentioned a patient could increase physical condition safely was through isometric strength bearing exercises – exercises without movement.

It is also imperative the patient is medically ready for surgery. Adair said, “We do an overall prep and make sure the heart, the lungs and the skin (are) in good shape.”

Being knowledgeable about what is going to happen during surgery can help allay fear of the unknown. Many hospitals offer preoperative education, which can be reassuring and take away the fear of surgery.

“The hospital stay is boring. It is a boring day,” Adair said. “Everyone is nervous, but if you went to the preoperative education, then you know what to do and prepare for.“

Prepare for after the surgery by removing extraneous stress at home prior to surgery. Planning surgery with enough time for recuperation before being in the fields was one major thing Adair addressed.

“The home should be as good as it can be. The patient will need to focus. Everything should be taken care of before surgery,” he said.
“Remove all dangers of floor slippage,” Gee added. “Watch pets, kids and items on the floor, because it is easy to trip since when first home; you won’t have the balance you did prior to surgery, for a while.”

After surgery, take advantage of physical therapy options to get moving more quickly. Most patients are only in the hospital for a few days before being sent home or for recovery.

While in the hospital, arrangements for home health care will be made for the first few weeks for both a nurse and physical therapist. After the initial homecare, the farmer will probably have physical therapy sessions until mobility has returned.

“Once you are home and receiving therapy, get after it. Make a commitment and get the right mindset,” Adair said.

Gee agreed a patient needs “lots of movement. Maintain as much range and motion as possible for stability and soft tissue. Everything gets better nutrition when it moves.”

Most patients can expect a pretty full recovery. “The vast majority of patients have no limitations on their lifestyle,” Adair said. “Knees wear very well, ordinarily.”

He added not to do activities that include jumping or high-impact. He gives stern warning to farmers that when working in the fields, there should be no jumping off tractors, combines or trucks.
Adair paused to look in on a farmer patient who had recently fallen in a grain bin and had a recovery setback. “Just use common sense,” he added.

Gee warned knee replacement is serious business, without a quick fix, and the patient will need time to recover.

“It is usually a full year to recover,” he said. “Six months into it, you will say, ‘I wish I had never had it.’ A year later you will be saying, ‘Why didn’t I do this sooner?”