BY LORI ACKEN | PHOTOS BY DAVID SZYMANSKI
Dr. David King
At age 44, I had a knee- and partial femur replacement — procedures most common to patients aged 70-plus.
It was early 2010 and I was an unfailingly healthy working mom with four teens, a hectic career and, unbeknownst to me, an egg-sized tumor rapidly destroying the end of my right femur. Early one morning, I stood at the top of the staircase, ready to rally the troops; the next, I was sprawled at the bottom, wondering why my leg had suddenly given way.
Shrugging off the pain, I limped on with my life. But the pain stuck around. Really stuck around.
One month and multiple doctors, scans and X-rays later, I sat in the Froedtert Hospital office of Dr. David King, listening as he explained that the cause of my weakened leg and persistent pain was a giant cell tumor of bone, a rare and benign but aggressive mass that had nearly broken through my femur. I was stunned. I was young. I could carry Chelsey, our quadriplegic oldest child, up multiple flights of stairs and hoist her wheelchair into the back of my SUV with ease. I biked. I camped. I traveled. And I was certain that life as I knew it (and liked very much) was over.
I was in the right hands.
For King — now the Paul A. Jacobs, MD, Endowed Chair in Orthopaedic Surgery at the Medical College of Wisconsin — and his colleagues, the very nature of bone tumors, benign or cancerous, means that most patients seek help only when they’re in dire straights. Plenty are in the prime of their lives.
“The typical tumor has been there for four to six months before anybody really experiences symptoms from it,” King explains. “Even when they do experience symptoms, almost everyone thinks they just pulled a muscle or overdid it and assume they’re going to get better. Oftentimes, it’s a second event that causes them to come in and say, ‘This isn’t right.’ Or a family member says, ‘You’ve been limping for four weeks. Go in and see somebody.’”
King begins by assessing the type, location and scope of the patient’s tumor to determine potential treatment options. But the next step, he says, makes all the difference in the world. “You come to see a physician expecting of them a level of expertise to manage the technical issues,” he says. “But it’s that ability to individualize your care based on what’s important to the patient and to really make that connection that separates a regular doctor from somebody that really has an impact on a patient and their life.”
In my own case, resuming Chelsey’s care — quickly and for a lifetime — meant everything. “That was an absolutely crucial piece,” says King. “I could see how hard that was on you, the longer you were away from caring for her the way you were used to.” To get me back on my feet — and home to my family — as soon as possible, we agreed that King would remove the tumor and fill the space with bone cement. But the tumor’s destruction proved too extensive and the bone around the repair gave way weeks later.
We quickly agreed on an aggressive backup plan: a titanium rod to replace the damaged femur, anchored to a prosthetic knee. I walked on my “new leg” hours after the surgery. “Certainly we could have plated it,” King says. “We could have tried to bone graft or other things to try to get that native bone to heal — but that was all going to keep you off of that leg for another three to six months at a minimum. And it might not have healed.”
Six weeks later, I put down my crutches for good. And though a crucial physical therapy regimen was foreshortened by a breast cancer diagnosis (I’m now cancer-free), changes to my gait were imperceptible. When my cancer treatment ended, I once again biked and camped and traveled the world.
“We personalized your care together — shared decision-making, which I think is really what personalized medicine ultimately should be,” King says. “I say this to people all the time: There is no crystal ball. We don’t know what that journey is going to look like. We just have to take it one step at a time, and it’s incredibly important for a physician to remain positive. I never wavered in the fact that you would be fully functional again and back doing all the things you want to do.”
King is also optimistic that the ongoing research that is the backbone of the Medical College of Wisconsin will continue to reduce physical and mental stressors on orthopedic patients, often keeping them out of the hospital altogether.
“There are medications that we use now that can stop a tumor’s growth, allow the bone to form a rind around it, and strengthen [the bone] a bit before we go in there. … It doesn’t work on every patient, but it’s an option,” he says. “The other thing that we’ve really started working with is embolization and ablation techniques, where we go in and essentially either freeze the tumor or burn it. Then we can inject cement into that defect to help stabilize that bone. It’s pretty cool.
“The primary goal of orthopedic surgery and the research that has been done over the last 20 years is to halt the aging process or arrest it with stem cells and regenerative medicine, so that maybe patients won’t need knees replaced or hips replaced as things wear out, ” King continues. “And we’ve gotten better at doing those replacements and getting people back to active lifestyles. We’re getting a lot of our patients out of the hospital the same day as their hip and knee replacement surgery. It’s incredible — and I think that curve will just continue to be pushed.”
|Dr. Rory Wright|
A Marathon. Then A Sprint.
Arthritic knee pain had been part of Milwaukee School of Engineering professor DeAnna Leitzke’s life for as long as she could remember.
Undergoing her first round of reconstructive surgeries in her early 20s, the energetic Shorewood native recalls her surgeon lamenting the fact that Leitzke wouldn’t be a candidate for knee replacements for another 20 years.
Leitzke married her high school sweetheart and the pair became parents to three active young sons.“But I was looking forward to turning 40 so that I could get my knees, because it really did get to the point where I was just watching my boys, and watching life happen around me,” Leitzke, now 42, admits. “I felt like I was always 20 steps behind.”
But it was another kind of parenthood moment that made Leitzke adamant that new knees needed to be a part of her near future. “My youngest fell off his bike,” she recalls, her voice catching at the memory. “He was halfway down the block, hurt badly, and I had to just walk to get to him. I felt like the world’s worst mom. I wanted to run to my baby and help him — and I couldn’t run.”
A patient of Cedarburg’s Blount Orthopedic Associates, S.C. since her teens, Leitzke made plans for her long-awaited knee replacements with Dr. Stephen Kurtin, diligently prepping herself, her home and her family for the complex surgeries and arduous rehab that would follow, and arranging for colleagues to cover her classes. “And then [Kurtin] moved to a different hospital,” she says.
Because Leitzke was adamant that her surgery be done at Orthopedic Hospital of Wisconsin (“Their reputation is phenomenal,” she explains), Kurtin steered his patient to his longtime colleague Dr. Rory Wright.
It wasn’t a match made in orthopedic heaven — at least at first.
|“The implants today are technologically sound enough that they can do tremendous things,” says Dr. Wright.|
Though Leitzke knew Wright’s reputation was impeccable, she found his approach too cautious for her taste and her timeline. And though Wright fully appreciated the literal decades Leitzke had waited for relief and the effort she’d put into planning her downtime, he knew rushing into the procedure would benefit neither doctor nor patient.
“No decision was made at the first visit … or the second visit or the third visit, because we had to do a little mutual arm-twisting,” Wright says. “She was twisting my arm to get her procedure and I was twisting hers to listen to me carefully and understand the decision she was making. At the end of three or four months we came to an agreement that she would work very hard and demand an excellent result of herself, and we would do the best we could to provide that for her.”
Because of Leitzke’s age and overall excellent health, Wright performed a simultaneous bilateral knee replacement — which accounts for just 10 percent of all knee replacements — on April 15, 2016. And Leitzke soon found out the true extent of her family’s love. The man she began dating at age 15 “was literally caring for me and helping me bathe. But then also my boys, it was crazy to me how much they stepped up to take care of me. That was so beautiful, so sweet. And they’re still like that.”
Wright and Leitzke each stress the importance of an equally trusting relationship between the patient and their physical therapist in assuring an optimal recovery. “My therapist, Crystal Toll, I cannot say enough wonderful things about her,” Leitzke enthuses. “One of the things she said, which resonates with me today, is that when you go through a surgery like I went through, you’re never going to have another situation where you can make such great gains in such short period of time.”
“The higher you set your goals, [the] more that you will achieve,” adds Wright. “The implants today are technologically sound enough that they can do tremendous things. They can cycle, they can endure unlimited low impact exercise. People can play doubles tennis, golf and hike and fish.”
Or in Leitzke’s case, complete a triathlon — an activity she enjoyed before her arthritis became too severe — in August, with her sister as her partner and her family cheering her on.
Leitzke did her best to adhere to Dr. Wright’s instructions to keep prosthetics with an optimal “lifespan” of 15-20 years intact as long as possible, opting not to run as part of her training and walking much of that portion of the race.
“I finished on my own two feet and that was my goal,” says Leitzke. “I knew I wasn’t going to win the thing, but I got a best time for me — and to do that at 42 after all I’ve been through, I felt like I won the thing!
“When I was at the end, all of sudden my sister was there again with my niece and my youngest son,” she continues. “He ran with me, side-by-side, right when I didn’t think I could anymore. He was there, cheering me on and saying ‘You can do it, Mom!’” Leitzke recalls, choking up again. “Then I saw my husband and my other two kids at the finish line and it was like ‘Hell yes, I can finish the race!’ … It felt so good for them to see me as being strong again.”
|Superior capsular reconstruction restored full range of motion to Dr. Pennington’s patient Joe Hasler.|
A model of SCR beside a traditional arthroplasty.
A Superior Shoulder Repair
In 2015, local restaurant owner/manager Joe Hasler underwent shoulder surgery to repair rotator cuff damage caused by decades of weekend athletics and a physically demanding job. He followed his doctor’s orders, completed his follow-up therapy and hoped for the best.
“I’m a motorcycle rider. I swim. I’m on the boat a lot. Just busy kind of guy,” says Hasler, 61. “My job is in the restaurant industry, so it’s lifting, moving fast and in a lot of different directions. When you’ve got pain like that, it really takes away from your day. Sometimes it’s hard to stay positive because you’re just not yourself.”
The pain subsided, but Hasler’s previous, bustling lifestyle still seemed out of reach. Then he fell on the job. His shoulder issues returned, worsened and then became unbearable. Hasler did his homework and found himself in the office of Dr. William Pennington, hoping to at least ease the pain and restore some semblance of normal function.
His timing could not have been better.
For several years, Pennington and his team had been researching and refining a new rotator cuff repair procedure called superior capsular reconstruction (SCR) that was not only less invasive than traditional surgeries, but could offer relief to younger, active patients with massive, debilitating rotator cuff tears for whom those surgeries had failed or were no longer an option.
Pennington, who practices at The Orthopedic Institute of Wisconsin and Midwest Orthopedic Specialty Hospital, discovered SCR when its founder, Dr. Teruhisa Mihata, presented the procedure at an international gathering of orthopedic surgeons. “He came up with it about 10-15 years ago,” Pennington explains, “and the reason he invented this operation was because in Japan they didn’t have a reverse shoulder replacement. They still don’t, so he developed a procedure where he used part of the patient’s own body to reconstruct that superior capsule.”
The rotator cuff is a set of muscles and tendons that encircle the ball of the shoulder, keeping it centered in the shoulder’s cup and allowing the arm to move easily in multiple directions. When those bones and/or tendons shift or wear out, traditional surgical options include repairing and re-affixing torn or shifted tendons to the top of the upper arm bone, or in more severe cases, replacing the ball and cuff of the shoulder with prosthetics.
“Mihata said, ‘I know [these patients] don’t have a rotator cuff anymore, but we can rebuild the top of the shoulder. We can basically, from the cup, attach a big piece of soft tissue and bring it out over the ball that will push everything down to re-center it, then just sew the remaining rotator cuff tissue to it, and that’ll center the ball into socket so that deltoid can work again.”
Pennington and other American surgeons picked up the ball and ran with it, subbing in cadaver skin and tissue for the patients’ own, and refining the procedure to a 90-minute arthroscopic surgery. For Hasler, the prospect was music to his ears.
“When he started talking about putting cadaver tissue in there, that made sense — because this is new, healthy, fresh tissue,” says Hasler. “I’ve been a donor myself for a long time, because I thought I might help somebody else. I never thought somebody else’s tissue would be in me at this point in my life, but it just totally made sense.”
Hasler underwent SCR in January 2018. In Pennington’s office on this late August afternoon, he happily swings his arm above his head to demonstrate the outcome.
“It feels great,” Hasler marvels. “I don’t even think about it. I go to the gym. I’m lifting weights to build the strength back. I started to throw the ball again. I don’t have the distance, but I’ve got the motion with absolutely no pain.” (“Now, you’re giving me chest pain,” Pennington chuckles at that last part.)
In addition to providing stellar results to a traditionally complex subset of patient, Pennington points out that SCR leaves the door open for evolving therapies and procedures — or traditional surgeries, should the need arise. “When we give talks about this procedure around the country and the world, we say, ‘the advantage of this is it burns no bridges. You still have your ball, and you still have your socket,’” he explains.
In a study published earlier this year in Arthroscopy: The Journal of Arthroscopic and Related Surgery, Pennington and his colleagues observed a 90 percent satisfaction rate among 88 patients ranging in age from 27 to 79 years. “We had the largest clinical series in the world right now with this,” Pennington says. “There are a few centers within the United States and, together, we’ve done the most.”
The surgeon also has high hopes that the potential for other less invasive procedures will evolve from SCR.
“This guy from Japan came to our meeting and I was sitting in the audience and talked to him afterwards,” Pennington says. “I came back from that meeting and one of the first patients that I saw in the office that Monday, I said, ‘I’m doing this operation.’ My PAs looked at me and said, ‘What are you talking about?’ and I said, ‘You’ll see. It’s going to be big. It makes sense.’ And it has. It’s really helped a lot of people.” MKE