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April 19, 2014

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Health care:

Knee-replacement advances help Hall of Famer gain his pain-free wish

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Los Angeles Rams Tom Mack is shown in this 1973 photo. Mack was voted into the Pro Football Hall of Fame on Jan. 30, 1999.

Over a 13-year NFL career as a defensive lineman with the Los Angeles Rams, Tom Mack crushed and tackled opponents with his 6-foot-3 frame and 250 pounds of bulk.

When his playing days were finished, Mack felt great. His body was free from serious injury and he was ready to move into a new career as an engineer.

But eventually, he began to notice pain in his knees. He had become used to dealing with injury during his career, but this was different. Basic tasks — such as golfing, walking and even driving — became painful.

The 69-year-old Henderson resident, who was inducted into the NFL Hall of Fame in 1999, began searching for a doctor who could make him pain-free.

He found Robert Tait, a Harvard-trained surgeon and co-owner of Orthopaedic Institute of Henderson. Tait is the first physician in the Las Vegas area to offer knee replacements made to order through CT scans and 3-D printing. Because the implant and surgical instruments are designed for each patient, Tait said, it addresses the main driver of patient dissatisfaction with knee replacement: residual pain due to poor fit.

"A light bulb went on in my head,” Tait said of his introduction to the custom-made knees through a manufacturer called ConforMIS. “Really, it’s the only thing I’ve seen in 20 years that holds on to the hope that we can utilize the computer before we go into the OR (operating room).”

What Tait found was he could go into surgery with a better idea of how an artificial knee would fit each patient.

Mack’s was just one of more than 3,000 knee replacement surgeries Tait has performed in a 20-year career. In that time, the number of knee implant procedures has risen markedly nationwide.

A September report in the Journal of the American Medical Association looked at knee replacements from 1991 to 2010 among 3.5 million Medicare patients. The study found a 161.5 percent increase in procedures during the study period.

The annual number of procedures in the United States now stands at more than 600,000 — at a combined cost of about $9 billion, the study notes.

"This growth is likely driven by a combination of factors, including an expansion in the types of patients considered likely to benefit from (total knee replacements), an aging population and an increasing prevalence of certain conditions that predispose patients to osteoarthritis, most notably obesity," the study authors wrote.

Tait said most of the surgeries he has done have been with off-the-shelf knees, but he recently made the change to custom implants.

He said about 1 in 5 people have some sort of residual pain with off-the-shelf implants, a number he says is cut by about 20 percent with a custom-fit knee. Additionally, Tait says the ConforMIS knees are at least $10,000 cheaper than custom-fit replacements used to be.

And though Mack hasn’t had any pain in either knee (one a standard joint, the other a CoforMIS model), not all patients are so lucky.

With his new knees, Mack can do whatever he wants — without pain. He can make his weekly golf games, though with a 26 handicap, he insists that his skills have to catch up with his pain-free knees.

“What you suddenly realize is, ‘My god, all the nagging pain I had is gone,’” Mack said.

As for limitations, Mack doesn’t have any. Like in the old days, he can walk and drive a car without a problem. And though he’s cleared to do athletically rigorous activities such as skiing and running, he doesn’t mind leaving that behind.

“I don’t run because I don’t really have much interest in it,” Mack said with a laugh. “I figure I used to do it for a living and that’s enough.”

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  1. As a former marathon runner, whose knees are shaky at best, I had replacement surgery on my right knee two years ago. Now the knee is A-OK. But a funny thing happened. I developed the Senior Shuffle. I walked like a duck. So I talked with my surgeon, and he said the surgery results from the new knee being shorter than my original knee! I asked him if I could run again. He said the problem was that I would wear out the new knee in a couple of years. So while there is give and take on knee replacement surgery, I'll take it. Getting rid of the pain makes it worthwhile.