Seventeen years ago, Vicki McCulley, then age 40, tried to show off while on the tire swing over her lawn as her family gathered for dinner on Easter Sunday. "I was being a hotdog," admitted McCulley, a member of the Yurok, the largest Native American tribe in California. She fell, overextending her knee and tearing muscles and cartilage. Since then, she's had surgery to repair the meniscus cartilage, cortisone shots and various treatments aimed at reducing the ongoing pain in her knee. By summer, the pain and accompanying stiffness was severely restricting McCulley's lifestyle. "I'd been walking like a crab for a long time," she said. "I was always in pain. I just wanted to be able to walk with my grandkids, not run a marathon. It seemed like we'd go places and I'd end up sitting in the car." McCulley's doctors in Humboldt County acknowledged that there were parts of her knee that had no cartilage, where it was bone on bone, but told her she was too young to have a knee replacement. Eventually her doctors, Katie Terra and Robert Lyle, at the Potawot Health Villages, operated by United Indian Health Services, referred her to UCSF Medical Center. UCSF orthopaedic surgeon Kevin Bozic, who replaced part of McCulley's knee last August, said it used to be true that knee replacement was reserved for older adults because younger patients were considered too active. The artificial parts often wore out quickly in young patients, requiring another surgery. However, improvements in implant materials, less invasive surgical techniques and studies showing that knee replacement can substantially improve a person's quality of life suggest that more of these procedures can be offered to younger people. In fact, a National Institutes of Health conference on total knee replacement (TKR) in December 2003 concluded that knee replacement is a highly effective and relatively low-risk procedure that should be offered to more patients.
|Vicki McCulley at home in Humboldt County.|