Boyd W. Haynes III, MD
As Americans live longer, they often deal with the diseases and conditions that come with aging concurrently. For example, it is quite common to have adult-onset diabetes and arthritic joints that may need replacing at the same time. So, it certainly follows that some of us will develop, will be fighting or be in remission from cancer while also having arthritic joints that may need to be replaced. In this article, I’d like to address how I help patients navigate these treatment decisions so that they can have the best quality of life possible when dealing with both of these conditions.
When a patient has a consultation with me about a knee replacement and lets me know about having cancer in the past or present, I always defer to their oncologist before proceeding. Cancer is a life-threatening condition and although arthritis may be painful and debilitating, it most certainly takes a backseat in treatment priority when compared to cancer.
If the patient has active cancer and is in treatment with chemotherapy and or radiation, their oncologist will not allow knee replacement surgery to take place. Fighting cancer takes a tremendous toll on the body and the patient needs every ounce of energy they have to do so. They may have to have surgery to remove a cancerous tumor or tissue. The chemotherapy and radiation used in treatment also are extremely taxing on the body and the nasty side effects are legendary.
Patients with active cancer can however be treated non-surgically with many of the same treatments that I use for all patients, oral and injectable steroids and Viscosupplementation injections, such as Euflexa™ or Supartz™, which consist of hyaluronic acid. While we can’t replace the knee, we can do our best to manage the pain with these treatments and can also splint or brace and add assistive devices to aid in walking.
The patient’s oncologist and I will remain in close consultation as the patient’s cancer treatment progresses. Blood work will be an important measure of how the patient is progressing. A low white blood cell count (which can be devastated by chemotherapy) indicates a poorly functioning immune system which is more prone to infection. Low hemoglobin may signal anemia. Blood chemistry tests determine if the liver, kidneys or other organs are functioning well enough for the patient to withstand surgery. Because every patient is different, reaching lab levels safe enough to proceed with knee replacement surgery can’t be put on a timetable.
Once the Oncologist gives me the thumbs-up to proceed with knee replacement surgery and the patient is ready to proceed, I can move forward. I will also want to consult with the oncologist about what chemotherapy drugs were used, what areas of the body may have received radiation, etc., as these treatments can have detrimental effects on bone density and I may need to make adjustments to the surgical plan for the patient’s safety. Rest assured, I will do everything in my power to ensure that my patient has the best outcome possible and success with their new knee.
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