Golf Doctor
(orthopaedics)
Why Does My Knee
Click?- A little noise from your
knee during golf is not necessarily bad!
Michael Leighton, M.D.
Dear Golf Doctor:
I am 79 years old and had my kneecaps replaced six months ago.
As I was promised, my doctor let me start playing golf three months
after surgery and I've been playing full rounds for the last six
weeks. My problem is that I get a "clicking" sound every time I bend.
It happens only on my right knee, not my left. What's the problem?
&endash;Howard White, Boynton Beach
Dear Howard:
I am sure at this point you feel very fortunate that you can
play golf and, since you didn't mention it, without significant pain.
My sense is that you had your entire knee joints replaced...not just
your kneecaps. Replacing kneecaps alone is an extremely
unconventional operation and if that is suggested to any of our
readers, I recommend a second opinion. Many of you are familiar with
knee replacement. The Learning Channel shows the operation at least
once a week and many of my patients feel that, given a saw and
mallet, they're ready to give it a try! It's not that easy, but then
again, neither is hitting a knockdown 9-iron into the wind to within
2 feet from the hole and I think I can do that!
When joints become arthritic, or lose their cartilage covering,
bone starts to become exposed and painful chemical mediators are
released on to the joint. A joint can become swollen, warm, stiff and
especially, painful. When the pain is very severe and other
conservative measures (to be discussed at length at a later date)
fail, your orthopaedic surgeon may suggest a knee replacement. The
entire end covering of the femur (thigh) is replaced with a specially
prepared metal alloy and the upper surface of the tibia (shin bone)
is replaced with ultra-slippery durable plastic that sits in a metal
tray. The other portion of the joint that is typically replaced
(although this is a very hot topic in the trade) is the patella
(kneecap). The undersurface half of the patella is removed and
replaced with a dome-shaped piece of plastic. It is replaced because
the patella is almost always arthritic and when it is not arthritic,
the long term results of leaving cartilage (patella) against metal
(femur) are not known. The "clicking" to which you refer is coming
from the movement between the patella and femur. IT IS NOT ABNORMAL.
About 50 to 70 percent of knee replacements will have a sound or
click.
Total knee replacements have excellent longevity. Many studies
report 95% survival rate at 15 years. That means that at age 94,
Howard, you have a 19 in 20 chance to having each to those knees
still in there working well, not needing to be redone. Remember
however, in the short term, this is not nor will it ever be the same
as your original knee before it became arthritic. But it is not
painful and that was the purpose of having the operation, right? The
fact that one knee clicks may be secondary to some normal scar tissue
that has formed around the patella in the knee that doesn't click.
It's not good or bad, just quieter! Total knee replacements usually
take a full year for all the stiffness, swelling and kinks (that's
not a medical term) to work themselves out, so sit tight. You might
also want to bend when standing closer to your buddies on the green
when they are putting - but that might be unsportsmanlike!
Michael Leighton, M.D. is an avid golfer who specializes in
orthopaedic surgery and sports medicine. He can be reached at
Atlantis Orthopaedics, 561-967-4400 or by e-mail at
KNEESURG@aol.com
