A knee replacement surgery is, technically speaking, elective. For the roughly 600,000 people who undergo one in the United States each year, it sure doesn’t feel that way.
In late 2019, Teresa “Tess” McDowell counted herself among those suffering masses. She’d been active all her life – playing sports as a kid, hiking and biking and generally being on her feet a lot as an adult – and there was wear-and-tear on her hinges.
In 2004, she had had cartilage in both knees cleaned up arthroscopically. The left had long been a bit worse off: three decades back, a friend had suggested using toe clips on her bike for more powerful pedaling. It worked great until she stopped at one point and couldn’t quite extract her foot before the bike toppled with her on it. Bam went her knee on the pavement.
As the years ticked away, the pain in her left knee climbed the scale. Meanwhile, Tess and husband Don’s three kids had kids of their own. A joint that had been an annoyance became a constant issue. Irritation blossomed into knifing pain. When she stood from a seated position, she had to take a moment to mentally account for both balance and pain level before setting off walking. A longtime climber of stairs, she became an elevator hunter. She could no longer hike with her daughter and grandkids. When she did take stairs, she took them one at a time. She did water aerobics in the deep end. She was feeling like, as she put it, “an old grandma.”
“I don’t want to be an old grandma. I want to go to kids’ soccer games – we’ve got nine grandchildren, five in the state,” Tess said. “I want to be involved in stuff.”
There was no last straw, but a Rockies game last September does stand out as a watershed moment. The family was there celebrating her grandson’s 20th birthday. The family went down to the field to watch the postgame fireworks. She realized that, if she sat on the field, she wouldn’t be able to get up again. Her grandson and others hoisted her after the smoke cleared.
A referral: surgery for knee arthritis
Tess’s daughter, a former soccer player who had dealt with knee problems related to that avocation, told her, “Mom, you need a knee replacement.” She recommended UCHealth Steadman Hawkins Clinic – Denver, renowned for its sports medicine and knee-problem expertise. There she met with Dr. Martin Boublik, a Steadman Hawkins Clinic – Denver cofounder, orthopedic surgeon, and sports medicine specialist who is also the Denver Broncos’ head team physician.
Boublik ordered X-rays, considered the arthritis evident in that left knee, and told Tess, “You’re going to need a knee replacement.”
“I started to cry,” Tess said. She knew people who had had bad experiences. “It’s scary – just the fear that I wasn’t going to be able to walk again.”
Tess is not generally a crier. The last time she had done so? Two years earlier, with the news of her breast cancer diagnosis. That would lead to a most nonelective surgery: her February 2018 double mastectomy.
Boublik reassured her that the success rates were high, and that, while it’s a serious surgery, experienced surgeons have made them routine. He added, though, that he wasn’t such a surgeon.
Boublik and colleagues at UCHealth Steadman Hawkins Clinic – Denver are sports-medicine specialists who, when it comes to knees, focus largely on repairing and rehabbing ligaments and cartilage damage. Joint replacement is a specialty unto itself. The UCHealth system, though, had a deep reservoir of joint-replacement expertise, and one orthopedic surgeon in particular, Dr. Ryan Koonce, had established himself as a go-to UCHealth Steadman Hawkins Clinic – Denver partner for cases such as Tess’s. She made an appointment with him.
With it again
Koonce operates at UCHealth Highlands Ranch Hospital. When Koonce introduced himself in the exam room in October 2019, Tess said something along the lines of, “I’m just a 71-year-old grandma and not sure I’m worth your time.”
Koonce believed otherwise and told her as much. They got to talking about prior surgeries. Her breast cancer procedure came up. He told her that breast cancer patients have a special place in his heart: two of his close family members were also survivors. That Tess’s son Brian is a triathlete, as Koonce also is, provided more common ground.
“There are some patients you have a really quick bond with, and we kind of had that,” Koonce said.
He gave her a book he told her would bring her up to speed on the procedure: Your Knee Replacement: A patient’s guide to understanding knee arthritis, preparing for surgery, maximizing your outcome. Don read it first, then Tess did. It was a huge help, she said. Plus, she knew the author personally: Ryan C. Koonce.
The surgeon didn’t just rely on his book conveying the key information relating to her surgery. He took the time to answer Tess’s and Don’s questions.
“He listens to you,” Tess said. “You never feel like he’s a hand-on-the-door doc who can’t wait to move on to the next patient.”
That’s deliberate, Koonce says.
“We pride ourselves on – and really focus on – patient education,” he said.
That manifests in three ways, he adds: they “try to spend a little extra time with patients in clinic to make sure they understand the procedure; they hand out the books (Koonce wrote a similar tome on hip-replacement surgery, of which he performs more than 200 a year); and they have patients attend a class with Lori Gross, a nurse navigator.
“My philosophy is that patients who are educated are happier with their care and have better outcomes,” he said. “It’s just a win all the way.”
Koonce described Tess’s procedure of Nov. 4, 2019 as “a routine total knee replacement.” That’s something of an oxymoron for a major surgery, but when you do 200 of them a year, which Koonce does, a major surgery can become routine. Tess’s outcome reflected that.
She was walking unaided at 13 days and was off all forms of pain pills by then, too. She took her rehabilitation seriously – a must to ensure long-term improvement of the joint – and was, by the time she and Don left for a trip to Maui in early February, “at full function – I barely know it happened,” as she put it.
The trip itself was a success, too – one that involved walks along the beach, a whale watch on a small boat from which, before the knee surgery, she would have had a hard time getting in and out of; and some serious snorkeling.
“I can’t say enough about Dr. Koonce,” Tess said. “I’m a with-it grandma now.”