When I was first building my joint replacement practice in Long Island in the early eighties, I focused on doing the most difficult revison procedures. Just so you know, a revision is a re-do operation of a prior joint replacement that failed, for whatever reason. What else you need to know is that these surgical procedures are at least four to five times the magnitude of an initial “virgin” joint replacement. 
 
The biggest revisions I’ve ever done have involved an entire body transfusion. That means transfusing the entire volume contained in a human body, over 12 units of packed red cells, together with platelets (that help to stop bleeding by forming “white clots”), FFP, or fresh frozen plasma (which contains clotting factors, to allow the bleeding surfaces to clot and stop intraoperative and postop bleeding), and additional fluids, containing electrolytes (charged ions, like sodium, potassium, chloride, etc. that let the heart beat and the nerves work, among other things).

Many times, the loosening of the initial implants results from resorption of the surrounding bone, a process called osteolysis. This occurs as a biological reaction to extremely tiny wear particles of polyethylene, from the plastic parts of a joint replacement–kind of like “brake dust” that accumulates on your car wheels from the wear of your brake pads. This often leaves weak or missing bone, which has to be replaced with bone graft, large pieces and ground up fragments of banked human bone, harvested from donors who have died. 
 
In addition, removing bone cement from the inside of the bones is time consuming, tedious and takes its own toll in damaging and removing native bone stock. Fashioning and fitting these bone grafts to reconstruct the patient’s bones is often the reason for long operative times in the OR. It ain’t easy.
 
And of course, these monster surgeries are fraught with potential complications and much higher risks than the virgin cases. So a failed joint replacement is not a small matter, but a pretty big deal to fix.
 
The longest total hip revision I ever performed took 15 hours, though most were in the three to six hour range. In other words, these are enormous surgeries, on a par with the biggest open heart surgery or excising and grafting an aortic aneurysm, in terms of magnitude and metabolic stress on the patient.
 
And for all these reasons, many surgeons who are comfortable doing primary (virgin) joint replacements are not so thrilled to do revisions. They often feel, many times quite correctly, that they’re out of their depth, way over their heads. 
 
So why in the world would I WANT to attract these cases?
 
My reasoning was multifactorial. I was the only one in the region really trained to do revisions. Most guys wanted someone to clean up their messes, and if I developed the reputation of being an expert in revisions, it would be a great indirect advertisement that I was an ideal choice for doing the simple, “virgin” total joints, too.
 
The problem was that most surgeons wanted to ship their disasters out of town, by referring the case to a big kahuna in The City, so they wouldn’t be embarrassed by the failure of their surgery and wouldn’t be tacitly admitting that someone else in town might be a better surgeon. So I had to attract these cases by going to the patients directly, by word of mouth. And once I got them, I had to handle these cases very diplomatically, so as not to embarrass the prior surgeon.
 
Even in the OR, where my pal and assistant Steve and I would scrub and come swaggering into the room to save the day, like “The Pros From Dover” in the movie M.A.S.H., we were careful not to badmouth the prior surgeon. After all, the failure was often NOT the fault of the surgeon, but caused by factors outside his control.
 
I always felt the guy did his best and “there, but for the Grace of God go I.” Other hotshot surgeons of my acquaintance were not so sanguine or understated in this regard. But I’ve always believed that the Universe has a way of punishing that sort of arrogance, eventually. In any case, my behavior did not go unnoticed.
 
Gradually, the other surgeons in town (and in the entire region) grew to trust that I wouldn’t throw them under the bus to the patient and family. I enjoyed the repuation of a gentleman, as well as an expert in this field. So they began to send me their grief, I would ask them to scrub with me, so they would become part of the solution, maintain their contact with the patient and family, and be able to bask in reflected glory, when the new surgery restored the patient and relieved the pain, which fortunately was most of the time.
 
The point of all this is that surgery is NOT without risks. And these risks are magnified and multiplied when an initial surgery fails and needs to be revised. So, it follows that you should NEVER undergo an UNNECESSARY SURGERY. 
 
If you have knee pain, for example, you may be able to relieve your pain and restore your function, by using the methods I’ve outlined in my newest healing program, HOW TO AVOID KNEE SURGERY. See how here at  http://drbillsclinic.com/avoid_knee_surgery.html 
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to   http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

 In the Fall of 1973 I was a straight surgical intern at the Medical College of Virginia in Richmond. I had barely survived my first two months of training, given my gross disorganization, inefficiency and sheer terror that I would kill some poor patient by what I didn’t know. 
 
But gradually, apparently by osmosis, I learned what I needed to know, somehow developed patterns of ruthless efficiency (quite contrary to my nature) and logical analysis that remain with me to this day. Against all odds, I had survived and I had evolved into a pretty competent fledgling surgeon.
 
Having recovered from the prolonged anxiety attack that characterized my first two months, I looked forward to my new assignment at the local private hospital. 
 
What many people don’t realize is that interns are “farmed out” to a number of different affiliate hospitals during their training. This was to provide us with different perspectives and adequate clinical experiences, and provide those hospitals with the closest thing to slave labor,  since the Civil War.

So there I was, in my freshly startched white uniform, as I walked into the hospital’s surgical ward for the first time. As I walked into the Nurses’ Station for the first time, an elderly nurse, all in white, even stockings, with a stiff, starched nuses cap (nurses wore caps in those days) first noticed me and cried out, “Doctor on Deck!” 
 
And with that, everyone currently seated, all the nurses and orderlies writing or reading charts, who were in the Nurses’ Station, immediately jumped up in unison and stood at attention, facing me!
 
I naturally wondered who they were standing for and turned around to see who it was that commanded this almost military reaction. I figured, I should probably be at attention, too. Imagine my surprise when there was no one else there.
 
I was pretty dumfounded, that’s for sure. It never even occurred to me that they were standing for ME. The elderly nurse came over and took me in hand, and said, “Welcome, Doctor.” Wow. I couldn’t believe it. “Hi. I’m Bill Stillwell,” I said.  “Just call me Bill.”
 
“No,” she said, “you’re Doctor Stillwell, now.”  Apparently, I was expected to be a bit more formal than I was used to. With that, she turned to the other nurses, mostly female, but with a few males and orderlies, as well, and said, “This is Dr. Stillwell, our new intern.”
 
Much to my surprise, no one burst out laughing at me. Apparently, they were quite serious.

Now, I’d always been a pretty informal guy. Airs of any kind were not tolerated in my family or by my friends, and despite my abilities, I completely accepted these values. They were part of me and my world view. It would never have even dawned on me that I would or should command this level of deference. I mean, I was still a wet-behind-the-ears, junior doctor in training, hardly worthy of this display, and, to my mind, hadn’t earned their respect. So this was a brand new experience. In short, I was in shock.
 
The senior nurse smiled at me and took me aside. She advised me that I was in charge now, so it was appropriate that my subordinates show me respect. I still couldn’t wrap my head around it. This was obviously someone’s idea of a joke. I had no idea what I was doing and said so. The nurse said, “You know more than you think…”
 
Over the next couple of months, especially at night, she guided me, by asking innocently phrased questions that gave me an idea of what I should be doing, but without ever undermining my “authority.” We both knew that I was clueless, but she was very adept at teaching me, without seeming to. That old nurse taught me plenty and I owed her a lot. We both knew it.
 
At the end of my rotation, I thanked her for all her help and guidance. She smiled and told me that I had become a good doctor. “At least you listened,” she said. “Why wouldn’t I?” I replied. She was the only one of the two of us who had any idea of what they were doing. But apparently, some prior interns had resented her help and had refused to listen. Ego, I guess. Damn fools….
 
From that time onward, I was always a staunch nurse’s advocate. I never forgot that debt of gratitude. I don’t even remember her name, but I will never forget what she did for me and for the thousands of patients that my life eventually touched. 
 
The moral of this story is that you have to be open to help, when it’s offered. When you open yourself up to someone who has been there, to someone who KNOWS, then, with luck, you might actually learn something. That’s why, when I wrote my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN, which you can get at this link: http://drbillsclinic.com/eliminate_knee_pain.html   I wrote from the perspective of a surgeon AND a patient, who has undergone knee surgery, myself.  I also made sure to speak in your own language, NOT “medicalese.” 
 
I made it the hallmark of all my healing programs to get rid of the mystery and the obfuscating vocabulary, so you can access the underlying principles, which are actually pretty simple, once you understand them. You see, if you know WHY to do something, you’re much more likely to do what I tell you. And therefore, much more likley to get better, FAST.
 
So, if you want to relieve your knee pain and restore your function, then click here for FAST RELIEF:
http://drbillsclinic.com/eliminate_knee_pain.html
 
Have a great weekend, my friend. And be well. Talk to you again next week.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

When I switched on the compouter this morning in my study, I clicked on my email, as I usually do, to see what, beside spam and junk, was in the inbox. As you might imagine, I get lots of emails and referrals and requests for advice about knee pain, hip and back pain, arthritis and all the rest of it. Whenever possible, I try to help, if I can.
 
Oftentimes, that means referring the enquirer to one of my healing programs or books. Sometimes, I can give them some short term advice that may help. Of course, I’m limited by the fact that I can’t see, much less examine them, and I’m further limited by their description of their problems. 
 
Lay people know what they mean, but they often can’t express it well enough for me to understand what the problem is. We don’t share the same vocabulary when it comes to medical problems. That’s one of the most important contributions of my LITTLE GREEN BOOK (see it  at http://drbillsclinic.com/eliminate_knee_pain.html ), which translates a number of medical problems from “medicalese” into everyday plain English, so the average person can understand what we’re talking about.
 
Anyway, recently, I’ve had a number of questions from people who have already HAD surgery, usually arthroscopic surgery, but STILL have pain. As is typical in my experience, many tend to blame the doctor for screwing up the surgery. But in fact, persistent pain may be from residual arthritic changes inside the joint. And it’s now well accepted, backed up by two large studies, that arthroscopic  surgery for arthritis is pretty ineffective. So, it’s not uncommon to have persistent pain after that procedure.
 
Let me give you an example of what I mean. This is the most recent email from someone in this very situation:
 
“I have had arthroscopic surgery on both knees. My right knee is in really bad shape after surgery. I think the surgeon really must have botched it because I am in constant knee pain after being on my feet for a few hours. How will your exercises help with no meniscus left in my knee? By the way, I am 57 and the surgeon says I am too young for knee replacement. Can you help me strengthen my knees through exercising?  Thanks…”
 
And here was my reply:
 
“…Your problem is not uncommon. You may have had a torn meniscus, which the surgeon probably removed PARTIALLY (you generally try to leave some of it as a cushion, unless it is already completely shredded from degeneration).  However, most likely, he did NOT “botch it.” It’s just that you undoubtedly have ARTHRITIS in that joint, which arthroscopy CANNOT CURE. That’s the most likely source of your pain. 

“57 is NOT too young to have a total knee. But, there are a number of proven, very effective non-surgical methods that can help to relieve your pain, and restore your function, at least for a while. You may wish to get my newest healing program, HOW TO AVOID KNEE SURGERY   at http://drbillsclinic.com/avoid_knee_surgery.html
 
“Exercises help by increasing the stability and the support of the arthritic joint by increasing the mass and strength of the surrounding muscles. But they are only one method, among many others, that can delay surgery. If you have end stage arthritis, eventually you WILL come to a total knee. 
 
” But that day can be delayed in many cases–I had one patient I carried in this way for TEN YEARS,before he finally got it done. But remember, everyone is different, so you can’t predict how well these methods will work for you. Still, isn’t it worth a shot? 
 
” BTW, be sure you have your Total Knee done by a specialist in joint replacement, when the time comes. It’s a very technique dependent procedure, so a guy who’s doing a LOT of them will have better results and fewer problems and complications. Hope these  tips help. Good luck to you!…”
 
Hopefully, he’ll take my advice and click on   http://drbillsclinic.com/avoid_knee_surgery.html  He’s likely to find a highly effective combination of conventional and alternative measures and exercises that will give him FAST RELIEF from his knee pain and help him AVOID SURGERY, if that’s possible. How about you?
 
Til next time, my friend, be well. 
 
Yours for a pain-free tomorrow, 
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

When I first arrived on the scene in August of 1973, the other orthopaedic surgeons in Smithtown weren’t exactly thrilled to see me. I didn’t find out til later on, but my new Associates had been in a struggle for dominance in town with another large group and had been sort of “rubbing their noses in it,” about my coming into their practice–the first fellowship trained joint surgeon on Long Island. So, quite naturally, but unbeknownst to me, the other guys were more than a little peeved, before they even met me.
 
I had just completed the Aufranc Fellowship, arguably the finest and most prestigious joint reconstruction fellowship in the country. But like all residents and fellows, I had been part of the house staff in the hospitals in which I trained. I had no airs, no sense of entitlement and I hope, no arrogance. Training programs are all very cooperative: The patients always come first, but everyone is in it together and we all help one another, in a spirit of good-fellowship.
 
So, the motives and behavior that the other guys in town projected onto me, were wholely undeserved and were frankly mystifying to me. I had always gotten along with everyone–my nickname was “Easy Bill.” To be treated with suspicion, paranoia and thinly veiled hostility for (to my knowledge) no reason, right out of the box, was quite a shock. I was, in short, clueless about the now competitive nature of my relationship with the other surgeons. Welcome to ”Private Practice,” kid!
 
Since I had no inkling of what had provoked this response, I tended to be a little defensive and decided, “Well, I’ll show THEM.” And I did.
 
I did procedures that I had been trained to do, complex surgeries that no one else in town had even seen, much less done. And I was adept at scooping up free patients from the ER, making friends with the ER docs and nurses, the family physicians and internists in town, and especially the rheumatologists. I did consultations and saw patients in the office and the ER with the raw energy of the newly minted doctor.
 
I was aggressive in doing surgeries, like no one but a young surgeon can be. And although I NEVER did a surgery that wasn’t warranted, I tended to view all problems through the prism of my training: “If you have a hammer, everything looks like a nail.” As a result, it was a self-fulfilling prophecy–I BECAME exactly what my collegues had feared and was soon acknowledged as THE regional expert in my field.  And yet…
 
It’s an old, but true saying: “There are OLD surgeons and there are BOLD surgeons; but there are NO old, bold surgeons.” Things I did then, though strictly indicated, I would never do, or recommend today. Certain things you only learn through time and experience. And after nearly a quarter century in the Operating Room, I’ve learned that the very best surgery is the one you AVOID. I’ve learned to respect the integrity of the body and appreciate its capacity for self-healing. 
 
In short, I learned the wisdom of the non-surgical solution.
 
That’s not to say that there aren’t times when only surgery will do. There are. But many times, patience and the use of time-tested non-surgical solutions, from across the entire medical spectrum, conventional, alternative and complimentary, will help relieve your pain and restore your function–but do that WITHOUT SURGERY. And that’s why I wrote my newest healing program, HOW TO AVOID KNEE SURGERY. See it here at:    http://drbillsclinic.com/avoid_knee_surgery.html
 
Even if you don’t have knee pain right now, the methods and strategies revealed in this program will help you PREVENT conditions that result in pain. And, of course, if you DO suffer an injury, you’ll be prepared to get the right treatment, avoid mistakes and vastly improve your chances to AVOID KNEE SURGERY, if that’s possible.  So be smart, before the fact. BE PREPARED. Get your copy of this unique program, today. Click on the link NOW:    http://drbillsclinic.com/avoid_knee_surgery.html
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

Besides the fact that I am a hip & knee specialist, albeit retired from active practice, the reason that I decided to focus on knee productsfor the start of my “second career” on this web site is that knee pain seems to be a very common, nearly universal problem, especially in people of my age group, The Boomers.  It happens almost every day–someone will mention that they have a painful knee, or they have arthritis, or they have a knee that “gives out,” or some other problem. It doesn’t get the “press” that back pain does, but everybody seems to have it, in one form or another.
 
Hell, I’ve had it myself–as many of you know. There’s nothing quite like having the same problem as your patients to give you a whole new appreciation of what they’re going through. They call that empathy. When I had my arthroscopic surgery on April 15, 2000 (Tax Day–might as well get all the agony over with at one time), believe me, I had a brand new understanding of what all my patients over the years had been experiencing. 

The need for the surgery, as you might expect, was well documented by physical exam, and a positive MRI, that demonstrated a torn medial meniscus. It had been interfering with my walking and exercising and I had just had enough. I called two of my best buds in the Department; one was busy and didn’t return my call, but the other saw me right away. Hey, rank has its privileges, right? Well, he agreed that I needed the ’scope. So we booked it for the local Surgi-Center, which specializes in outpatient surgeries.
 
So on the big day, they rolled me into the OR, smiles all around. They started an IV and slipped me a little IV Versed (a short acting relaxant that has the side effect of short term amnesia). Very relaxing, almost pleasurable. I remember just a tiny stab of sharp pain in my left knee, where I needed a little more local anesthetic, otherwise, nothing. Woke up gradually in recovery, feeling fine. If you ever need to have surgery, this is called “conscious sedation” and it’s definitely the way to go.
 
As soon as I woke up sufficiently, they let me go and I went home. Set myself up in bed with my leg well elevated, with a big bag of crushed ice on it, to reduce swelling. At first, I was quite comfortable…then, the local anesthetic, injected into the knee at surgery, wore off. Oh boy! That was sore and even worse when I had to put it down to limp to the bathroom on crutches. So THAT’S what they were all complaining about. I suspected that MY surgeon had given me less anesthetic than I gave my patients. Took at least 2-3 days, before I could put some pressure on it.
 
Turns out I had a whole lot more pathology in that knee than I initially thought. That’s the thing about MRI’s and other interpretive examinations: the real thing is always worse than the scan indicates. In my case, a small area of bare bone under the residual meniscal rim, in other words, some arthritis. Now, with time, and me doing my own therapy, with the same exercises I teach at http://drbillsclinic.com/exercise_eliminate.html   I gradually improved, more and more.
 
But after my left knee recovered, the right started acting up. I thought about going through the same process that I had just finished on my left knee, and decided that the odds were good that I had a “mirror image” lesion (in other words, the very same pathology) in my right knee. THIS time, I opted to AVOID SURGERY and treated myself with all the various options I knew about from across the entire treatment spectrum: the best of conventional therapy, alternative measures, dietary changes, nutriceuticals, the works.

And it’s worked–so far, I haven’t had to have surgery on my right knee. And these same measures are those that I used for the over 90% of my patients, who I was able to treat without surgery. Now, I’ve put all these strategies and a number of healing programs into my newest product: HOW TO AVOID KNEE SURGERY. Go see it at    http://drbillsclinic.com/avoid_knee_surgery.html
Get rid of your pain, restore your function, and do it WITHOUT SURGERY. 

Til next time, my friend, be well. And have a great weekend.
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved