After her son died in a construction accident in downtown Grand Rapids 14 years ago, Deb Petruska took a job in the Kent City schools system.

“I thought it would make me feel better, being around the kids,” Petruska said, and it did. “They’re the reason I get up every morning after losing our son.”

But her job as manager of the Kent City Middle School kitchen became nearly impossible earlier this year as her knee arthritis worsened. She could hardly walk. The pain consumed her.

“Before surgery, it got really bad,” Petruska, 58, said. “I got home every day and felt like I was done. I couldn’t function at all. I didn’t even know if I was going to make it through my work day. I was actually using a (rolling food) cart as a walker.”

Five months after having knee replacement surgery, Petruska’s knees haven’t felt this good in decades. She has resumed gardening, something she gave up because of the pain. And she’s now planning on getting her right knee replaced as well.

“When they first got me on my legs after the surgery, I couldn’t believe my joint pain was gone,” she said. “I look back and I’d think: Why did I wait? I wish I would have done it sooner. I shouldn’t have let it get to that point.”

Fear of the unknown

Doctors perform more than 750,000 knee replacements every year in the United States. Between 2000 and 2010, the total number of replacements—also known as arthroplasty—doubled, according to The New York Times.

Arthritic patients like Petruska have surgery because the cartilage between bones in the knee has worn away, often creating painful bone-on-bone interaction.

Bryan Kamps, MD, a former Army doctor who specializes in orthopedic total joint surgery for Spectrum Health Medical Group and who performed Petruska’s knee replacement, said when patients have a mix of poor X-rays with severe pain, it’s time to consider surgery.

Despite many people’s fear of surgery, 70 to 80 percent of patients are pain-free after arthroplasty surgery, which can lead to a huge boost in quality of life, Dr. Kamps said. The majority of the remaining patients are “vastly improved,” but there’s something that’s not quite perfect, he said.

The key is to have surgery only under the right conditions.

If patients have a lot of knee pain but the X-rays don’t show advancing arthritic conditions, or patients have bad X-rays but only a mild amount of pain, they likely won’t get as much benefit from surgery, Dr. Kamps said.

“We liked to think as surgeons, we’ll pick patients who will do well,” Dr. Kamps said. “With Deb, we talked about non-operative and operative-treatment measures. After a period of non-operative treatment, we did a total knee replacement, and she’s done really well. She’s definitely recovered quickly. We’ve been very pleased.

“If you do surgery for the right reasons, based on the right indications, patients are going to do well.”

When Petruska started seeing Dr. Kamps more than two years ago, she originally didn’t want surgery. She tried cortisone shots and “viscosupplementation,” a process in which lubricating fluid is injected into the knee to increase mobility and ease pain.

But those treatments offered few sustained benefits. As her knee got progressively worse, it left her with no choice.

“Yeah, I was pretty scared,” she said of surgery. “On a 1-to-10 scale of fear, I was probably an eight. I was nervous going in. You don’t know what’s going to happen—it’s fear of the unknown. … But like I said, now I think, ‘Why’d I wait?’”

Ready for Round 2

In addition to picking the right patients, Dr. Kamps and Petruska both said post-surgery rehabilitation and physical therapy is key.

It has been for Petruska, who had six weeks of in-hospital therapy after her June 6 surgery, and continues to do outpatient physical therapy. The therapy and high-quality care she received made a huge difference, she said.

“I was on my feet immediately after surgery,” Petruska said. “And every couple of hours with my pain meds, (the doctors and nurses) were right there. … In probably less than four weeks, I was completely off my pain meds. I was taking ibuprofen occasionally, and that was it.

“I was worried once because I wasn’t able to do my exercises, and I thought I’d fall behind on my progress. But the doctors told me to only concentrate on progress, my husband helped me, and they were right. I did what I had missed, and I eventually did everything.”

She described it as “an overall great experience.”

“Great doctors, great nurses,” she said of Spectrum Health. “I knew going into it, I had to use my leg right away. I had a friend who didn’t do that, and her leg just froze up after surgery. I just made up my mind I would listen to the doctors and do everything—the exercises and rehab and everything—the right away. And it worked.”

Dr. Kamps said pain reduction and the ability to be high-functioning are the biggest benefits of the arthroplasty.

“I tell people they can pretty much do what they want after surgery, but we caution against too much impact-loading activities, like running. We say that’s probably not the best thing to do,” he said. “But tennis, skiing, bike-riding, swimming—basically anything else you want to do you can do.”

That’s been a revelation for Petruska, who has resumed fishing and gardening, including working on a memorial garden she and her husband created for their son after his death.

After fearing the first surgery, she’s now eager to have her other knee replaced.

“I just feel a whole lot better than I did last year, and that’s still with one bad knee,” Petruska said. “I really feel like it’s helped. My legs may feel tired at end of that day, but I don’t feel the joint pain. It’s been a complete success.

“Even the home care with outpatient therapy, it was incredible,” she said. “Since I was young, I was pigeon-toed, and the therapy has helped me with that. I just can’t say enough good things. I’ll have to have the other knee done, maybe next summer, and I have no doubt that it’s going to go well.”