PHOENIX — It isn't often you find a classy person like Dr. C. Andrew Laird hanging around joints like that.
But then it isn't everybody who is an orthopedic surgeon. And you certainly don't find many of those who, having stitched his last patient of the day, climb into the pilot's seat of a jet helicopter.
This ability comes in handy because throughout Arizona there is a waiting list of citizens with ailing joints, waiting for help. Quite often the response comes from a specialist who worked his way through medical school by flying crop dusters.
"She'll be walking tomorrow," Laird predicted, quietly cutting into the left leg of an 81-year-old woman lying anesthetized on an operating table at St. Luke's Medical Center here.
A good thing she wasn't awake, because she would have thought she was on the moon. Surrounding her in a laminar flow room--where the constant flow of filtered air replaced itself completely 300 times an hour--were five experts.
The surgeon, assistant surgeon, positioning nurse and instrument nurse all were dressed in blue paper gowns, hoods with plastic bubble masks covering their heads, exhaust hoses from the space costumes expelling their stale breath. At the patient's head, away from the incision, the anesthesiologist wore a more familiar sterile outfit.
"This woman couldn't walk a quarter of a block anymore," Laird commented to a specially clad visitor in the room. "Her arthritis was so bad that her knee hurt when she turned in bed at night."
Sometimes the repairing involves shoulders, elbows, hips--but often the patients have had it with aching knee joints. And getting a replacement seems to be about as easy as having a crown put on a tooth.
To save as much as possible of what is already there, this orthopedist has become something of a trailblazer in reviving what is known as single-compartment knee replacement (more on that later). But in this case a total knee joint replacement was the only solution.
"The X-rays tell me a lot in advance, but until I go in, I don't know whether we'll be doing unicompartmental or total replacement," the surgeon explained.
In simplified terms, the knee joint is the largest weight-bearing one of the human body. The lower end of the thigh bone (femur) has a rounded surface that moves in a shallow groove on the upper end of the shin bone (tibia).
"These two bones are covered by a cartilage cushion three-eighths of an inch thick, which is five times smoother than if you rubbed two ice cubes together," Laird said.
When the cushion is destroyed by inflammation or wear, pain from arthritis results.
"Actuarially, this person is looking at eight or nine more years of life," the doctor said of the patient in front of him. "Why should she have to sit on a rocker and watch the world go by?"
Many of those who come to him are elderly. Indeed, one was a 94-year-old Episcopalian clergyman, who underwent the unicompartmental surgery and now walks several miles a day.
Some have links to the famous. Jo Esterly, mother of actress Raquel Welch, had a total knee joint replacement done by Laird.
As for his newest patient, about 90 minutes had passed and the new parts were cemented in place. "When she leaves the hospital, she will be walking without pain," Laird said while heading for a break in his office.
Still ahead in the day was one more of these operations (often he does three a day). And then he would put another talent to use in visiting some of his recovering patients at a different hospital.
"That was the typical knee joint replacement, and the kind I have to do 80% of the time," the doctor said, munching on a doughnut. He had been up since 4:30 a.m., and it would be 10 p.m. before he would get to sleep.
Laird went on to recall how his training had included time with the late Sir John Charnley of England, who pioneered total hip replacement in the early 1960s, which in turn led to knee replacement in the early 1970s.
That has become the most popular procedure involving an ailing knee. And like nearly everyone else, Laird uses it most of the time. But for a dozen years, he has been championing a lesser-used and more conservative approach.
"I would rather have a crown put on an existing tooth than have a false tooth," he said. "In our unicompartmental surgery, we replace just one of the two sides of the joint. We leave as much as possible of what is God-given."
The procedure is akin to half-soling a shoe. Last year, before the annual meeting of the American Academy of Orthopaedic Surgeons in Atlanta, Laird presented a nine-year follow-up study of 184 knees on which he had performed the operation.
The study found that "92% of the patients (there were 139 of them) rated their knees as greatly improved, 5% as moderately improved . . . 85% were completely pain-free." A team of nurses, physical therapists and radiologists, after concluding research, rated pain relief good to excellent in 90% of the patients.