George W. Bush Undergoes Knee Surgery

Former President George W. Bush is resting comfortably at home in Dallas after undergoing knee surgery this past weekend.

Bush spokesman Freddy Ford said the the 67-year-old Bush underwent “successful partial knee replacement in Chicago on Saturday.” Although it has not been confirmed, it is believed that the surgery took place at Rush University Medical Center, which is world-renown for its joint replacement program.

Bush is well known as a competitive runner, and exercised routinely during his eight years in office. He reportedly switched to mountain biking in 2004, because knee pain made running difficult.

What you should know about the knee:

The knee joint is the largest joint in the body, consisting of 4 bones and an extensive network of ligaments and muscles.

The knee is made up of four main bones- the femur (thigh bone), the tibia (shin bone), fibula (outer shin bone) and patella (kneecap). The main movements of the knee joint occur between the femur, patella and tibia.

Each are covered in cartilage which is an extremely hard, smooth substance designed to decrease the friction as movement occurs between the bones. The patella lies in an indentation at the lower end of the femur known as the intercondylar groove. At the outer surface of the tibia lies the fibula, a long thin bone that travels right down to the ankle joint.

Each knee joint has two crescent-shaped cartilage menisci. These lie on the medial (inner) and lateral (outer) edges of the upper surface of the tibia bone. They are essential components, acting as shock absorbers for the knee as well as allowing for correct weight distribution between the tibia and the femur.

What can lead to a knee replacement?

Arthritis is the most common cause of damage to the knee that can lead to knee replacement. Arthritis can be caused by three things:

• Osteoarthritis- This occurs in people over 50. The cartilage that cushions the bones of the knee softens and wears away. Eventually, the bones rub against one another, causing knee pain and stiffness.
• Rheumatoid Arthritis- This is a chronic inflammatory disease. The lining of the knee joint, called the synovium, gets thickened and produces excess fluid, leading to swelling and joint stiffness. Chronic inflammation leads to damage to the cartilage.
• Traumatic Arthritis- Caused by a severe injury to the knee, such as a fracture or torn ligaments.

With total knee replacement, the surgeon removes damaged cartilage and bone from the surface of the knee joint and replaces them with a man-made surface of metal and plastic.

What is a partial knee replacement?

Photo Credit: AAOS

According to the American Academy of Orthopedic Surgeons, the knee is divided into three major compartments: The medial compartment (the inside part of the knee), the lateral compartment (the outside part), and the patellofemoral compartment (the front of the knee between the kneecap and thighbone). In a partial knee replacement, only the damaged compartment is repaired with metal and plastic inserts.

Partial knee replacement is available to only a small number of appropriate candidates- those whose arthritis is confined to a single compartment of the knee. The advantages include a shorter recovery time and less post-operative pain. Studies have shown that patients seem to think that a partial knee replacement “feels more natural.” The main disadvantage is that further surgery may be necessary if other areas of the knee become involved.

For more information, go to the Resounding Health Casebook on the topic.