Like many baby boomers, Clay McCaskey began noticing little twinges in his knees in his 50s; and like many of his peers, he attributed it to developing arthritic changes. “It started with just a little pain,” he remembers, “but it gradually got worse.” For anyone in his age group, the thought of losing function is upsetting, but for Larry, it was far more than that. He’s played racquetball competitively since the early 1970s – by 1977, he was the third ranked singles player in Virginia – and he had no intention of giving up the game. “Unlike a lot of people who play a little in the winter, and then move on to different sports when the weather warms up, I played racquetball year round,” he says, “several times a week.”
An engineer by training, Clay approached the worsening situation methodically, doing extensive research. He visited a surgeon in his hometown of Richmond, who told him he could give him some relief by arthroscopically removing a part of his meniscus, but he cautioned it would only be a temporary solution; Clay would eventually need a knee replacement. “I was only 58 at the time, and I wasn’t ready for that,” Clay says, because everything he’d read about knee replacements indicated he’d no longer be able to play racquetball – or any impact sports. “That didn’t work for me,” he says. “I’m a baby boomer, and I’m stubborn. I wasn’t going to put up with that.” He opted for the temporary fix of arthroscopic surgery.
The surgery did help, and Clay returned to the racquetball court – but, as with most arthritic knees, the pain eventually returned and got progressively worse. Still, he continued to play until “I got to the point where every step hurt. Ultimately, I was in so much pain that I couldn’t play,” he says. “I could hardly walk. It literally felt like an ice pick in my knee. I knew I had progressed to the point where I needed to investigate a knee replacement, because I had a bone-on-bone situation. You could see it on my x-rays.”
He researched the latest technologies with the same intensity he showed on the racquetball court, using his engineer’s training to identify the newest devices on the market. “I saw all kinds of appliances and learned about current knee replacement methods,” he says, “and I was intrigued by what I read about a company called Conformis, which manufactures custom knee replacements fitted to the patient’s particular anatomy.”
As he describes his research, Clay can’t help slipping into engineer mode – he was as fascinated by the technology itself as the restoration of function it promised. “They take a CT scan of your knee and make a custom appliance using computer technology,” he explains, “and they claimed accuracy within millimeters. As an engineer, that was impressive and important to me.”
Once he decided on the appliance he wanted, Clay went to Google to find surgeons in Virginia who had experience with the Conformis system. He found four, but one – Dr. Snyder – had two very definite advantages. “When I read his bio,” Clay recalls, “I found out that he played handball – a competitive sport even more strenuous than racquetball – so I knew he’d understand my motivation.”
Secondly, Clay learned, Dr. Snyder had had a knee replacement himself – at the Conformis factory in Boston. So impressed had he been with his own result that he undertook the training to enable him to perform the procedure in his practice in Newport News. Clay knew he’d found his surgeon. He made an appointment and drove the hundred miles to the OSC facility.
Dr. Snyder remembers their initial conversation: “Clay came to the office fully prepared. We talked for about 30 seconds, and he knew exactly the surgery he wanted. He was ready to get started.”
Because the damage was on the medial, or inside of Clay’s knee, Dr. Snyder was able to perform a partial knee replacement. Before this new custom-fitting procedure, patients like Clay, in their 50s with previous arthroscopic surgeries and little or no cartilage left on the inside of their knees, wouldn’t necessarily require a total knee replacement – although many surgeons did them.
Dr. Snyder explains: “Partial knee replacements have been around for years, but they never really caught on, primarily because they were technically very difficult to do. And because we didn’t have custom-fitted pieces, we’d have to try different sizes to get the best possible fit – during the procedure. Total knee replacements could be done more predictably and faster.” But now, he continues, “the technology has changed. These custom-made partial replacements are much easier to put in. Conformis digitizes the CT scan and makes a three-dimensional mathematical model of the knee that exactly mirrors the contour of the knee. The company also makes all the supporting instrumentation that goes along with the implant, and sends it to the surgeon pre-sterilized, along with a jig – a precise pattern – to use while making the cuts. Everything is ready to use, so we no longer need several trial sizes and trays of instruments in the OR.”
“Because it’s so precise,” Dr. Snyder adds, “I didn’t have to remove a lot of bone. I basically scraped away the residual bad cartilage, taking very little bone. The device sits in Clay’s knee like a crown sits on a tooth. Only the part of his knee that was bad was impacted.”
And because very little bone was involved, his recovery was far less painful and lengthy. Clay returned to Richmond the day after surgery, and immediately started in-home therapy. “Dr. Snyder arranged everything,” he remembers, and “after only 10 days, I started outpatient therapy.” He describes his progress as steady, and says his knee now looks normal.
The real proof for Clay of course, was to be found on the racquetball court. He tested his knee seriously about four months after the surgery, and was back at full throttle after six months. Today he still plays three times a week, but enjoys doubles more these days. He has a group of baby boomers he plays with regularly – one of his partners is 78 – and has no intention of slowing down. “From my research, I know that even with the minimal bone loss, I might need another surgery – in 15 years or so,” he says. “If I keep playing racquetball, that might very well come true.” Applying engineering standards, he likens his knee to a car – “it might last five years, it might last 15. It’ll depend on how I drive and maintain it.”
Should that day come, Clay says, he won’t hesitate to return to Dr. Snyder. And he’ll arrive for his appointment fully prepared with research in hand, ready to proceed.
Dr. Bob Snyder fixed my bunion on January 19th, 2019. I waited 8 months to evaluate my results because that is about normal for total healing. It came out perfectly – exactly in accordance with what Dr. Snyder told me was going to happen. Pain is gone. I’m wearing shoes I thought would never fit again. My foot looks normal.