April C Pain-Free with a New Knee

“In addition to my knee, my self-esteem, confidence and quality of life are a thousand percent better. Now I can’t sit still. I’m always on the move.”

Frustrated by joint agony, a woman finds a surgeon who listens—and helps.

For April Coleman, discovering that her orthopedist didn’t accept her new insurance turned out to be a blessing in disguise.

The mother of two from Bayonne had suffered from increasingly debilitating knee pain for 10 years. “It started with a meniscus tear,” she says, referring to cushioning tissue in the joint. The tear was repaired, but two years later, new pain led to a diagnosis of arthritis. By 2020, she couldn’t bend her right leg without extreme pain.

Cortisone injections helped ease her discomfort, but only for a week or two. When April turned down opioid pain medications, her orthopedist suggested she lose weight. “I was saying, ‘You don’t understand; I’m in excruciating pain,’” she recalls.

The doctor dismissed her pain because it didn’t prevent her from working, and told her she was too young for knee replacement surgery. “I felt like he wasn’t listening to me,” she says.

That’s when her insurance carrier changed—and she needed to look for a new doctor.

‘He Listened to Me’

April’s search revealed one doctor who stood out: Raphael Longobardi, MD, FAAOS, an orthopedic surgeon and a member of RWJBarnabas Health Medical Group.

“I was truly impressed with his credentials and reviews,” she says. At a March 2023 appointment, she saw why Dr. Longobardi got high marks: “He was knowledgeable, he listened to me, he validated me, he walked me through everything and he explained my condition and my treatment options without being condescending,” she says.

From her X-rays, symptoms and history, Dr. Longobardi confirmed that April had osteoarthritis. He explained that this degenerative disease results from the wearing down of articular cartilage, a smooth cushioning material that covers the ends of bones where they meet to form joints.

“Dr. Longobardi said, ‘Yes, losing weight will help you, but that’s not the reason for your pain,’” says April.

He started her on a physical therapy regimen to improve her strength and mobility, and prescribed an oral anti inflammatory medication for pain. This was followed by a cortisone injection, which didn’t help.

“The next step would typically have been a gel injection, but April did not want to do that, so we discussed surgery,” says Dr. Longobardi.

April was given details about the procedure and underwent tests to receive clearance for a knee replacement, which was scheduled for August 30, 2023, at Cooperman Barnabas Medical Center.

Despite knowing that the operation promised to relieve her pain, April was nervous. “Dr. Longobardi took my hand and said, ‘Don’t worry, everything is going to be just fine,’” says April. “That helped ease my fears.’”

Mobile and Active

The surgery was completed in under two hours. “I did it in the traditional way with intramedullary guides, where we put a rod into the tibia [shinbone] and one into the femur [thighbone],” Dr. Longobardi says. “Based on that, we realign the surfaces to put them in a more optimal position so the leg is straighter.” With surgery scheduled late in the day, April stayed in the hospital overnight.

“When I woke up, I had a nurse right by my side,” says April. “The nurses were amazing—they took great care of me.”

Most knee replacement patients are mobile with the help of a walker and crutches for about two weeks, followed by two weeks with a cane and no assistive device after that, Dr. Longobardi says. Within three months, patients typically resume regular activities, depending on how physically active and conditioned they were before surgery.

“April had hip-muscle weakness but stayed with the physical therapy program and did really well,” says Dr. Longobardi. “We worked on strengthening her hip and thigh muscles, and her hip and back pain also got better.” She underwent additional physical therapy after Dr. Longobardi removed dead fat tissue that had triggered an infection, which was treated with antibiotics.

“Dr. Longobardi said he would make me feel better—and I do,” says April, who has become an enthusiastic bicyclist. “In addition to my knee, my self-esteem, confidence and quality of life are a thousand percent better. Now I can’t sit still. I’m always on the move.”

Are You Too Young for a Knee Replacement?

Professional organizations such as the American Academy of Orthopaedic Surgeons issue no absolute age restrictions for knee replacement surgery: The decision should be based more on a patient’s level of disability, pain and joint damage than on age alone.

Yet while prosthetic materials and technology have seen many advances, knee implants have a finite lifespan. “All implants eventually wear down, which would necessitate having a revision knee replacement,” says Dr. Longobardi.

At younger ages, the odds of needing a revision surgery later in life go up. As a rule, Dr. Longobardi says, 50 is the youngest age he would consider a patient to be an appropriate candidate for knee replacement surgery. Exceptions can include cases in which relatively young patients have unusually severe rheumatoid arthritis and/or bone-onbone joint damage.

“If you get a primary knee replacement at 60, there’s a good chance it will be the only operation you’ll need,” says Dr. Longobardi.

Patients younger than 50 can benefit from other treatment options. “These include procedures that use biologic materials such as osteochondral [bone and cartilage] transplants and meniscal transplants [which use donor tissue],” Dr. Longobardi says.

Learn more about joint replacement surgery at RWJBarnabas Health or request an appointment with an orthopedic surgeon today.