PUMPING IRONY: Use ’Em or Lose ’Em

Most afternoons, when weather permits, My Lovely Wife will climb on her bike and head a couple of miles north to her favorite coffee shop. It gets her out of her studio into the fresh air and among people in that curious public-yet-private way we’ve come to expect from these venues. She enjoys her coffee, but there’s an ulterior motive often at work here as well: Nothing pleases her arthritic right knee more than the act of pedaling.

This is not a recent discovery. MLW has been grappling with that bum joint of hers for the better part of the past 40 years, ever since a freak accident on a dance floor in England sent her to a surgeon who removed way too much of her knee’s cushioning meniscus. Osteoarthritis gradually set in, which now causes the creakiness in her knee that bicycling typically relieves.

The Medical/Pharmaceutical Complex does not offer much in the way of palatable options for those, like MLW, whose prior experiences with conventional interventions tend to dampen their enthusiasm for total knee replacement and other surgical gambits. So, she was predictably skeptical when I mentioned the latest innovation in joint reconstruction: an implantable shock absorber.

The MISHA Knee System uses a piston anchored to the inner side of the femur and tibia bones with a small plate to ease stress on the joint. Results from a recent clinical trial at Ohio State University found the implant reduced pain and enhanced mobility among the 81 participants. As lead study author David Flanigan, MD, puts it, the shock absorber could be a game-changer for those who suffer from osteoarthritis but aren’t ready for total knee replacement.

“There really hasn’t been much to offer for knee arthritis between the more basic options like medications, therapy, and injections all the way to joint replacement,” Flanigan says. “This shock absorber could be an in-between step patients need.”

When I brought this up over dinner the other day, MLW wondered whether a newly piston-driven knee would result in some unintentional bouncing when moving from point A to point B, but she otherwise found the concept to be a bit at odds with her own experience as well as recent research suggesting that the best remedy for an old creaky knee is to start walking.

Baylor College of Medicine rheumatologist Grace Lo, MD, and her team tracked the progress of 1,212 older adults (average age of 63) suffering from knee osteoarthritis over the course of eight years. Their results, published in the journal Arthritis and Rheumatology, showed that those who walked regularly for exercise were less likely than their sedentary counterparts to experience new frequent knee pain.

The data is based on self-reported information, Lo is quick to note, and there’s little evidence to suggest that a regular walking regimen will heal an already damaged joint, but the fact that participants could walk regularly without feeling more pain than usual — and without causing further damage — may offer folks with bum knees an option that doesn’t involve a close encounter with a surgeon’s scalpel.

“The findings from our study provide a glimmer of hope that there may be an inexpensive intervention that modifies the structure and symptoms related to knee osteoarthritis, the most common type of arthritis and a source of substantial disability,” she writes. “Clinicians should encourage patients to walk and consider in-person or Web-based walking programs.”

MLW used to have an app on her phone that reminded her every night at 8 p.m. that “It’s a lovely evening for a walk” or some such enticement. And she occasionally responded by slipping on her sneakers and ambling around the neighborhood for a while. No matter how creaky her knee felt when she set out, it would eventually loosen up and feel OK by the time she arrived back home, a fact that seems to support Lo’s conclusions.

But she’s never really embraced the idea of an evening walk quite as lovingly as her afternoon bike ride. Pedaling to the coffee shop almost never fails to resolve whatever complaints her knee delivers, the fresh air and exercise revive her, and at the end of her journey there is always a pretty good cup of coffee.

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