Approximately a year and a half after his last knee surgery in early 2014 the Democratic governor of Missouri and Missouri politics fixture, 59-year-old Jay Nixon, has had both knees replaced.
Missouri Governor Poster Child for Bilateral Knee Replacement
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Gov. Nixon, a second-term governor who had served four terms as attorney general, is an avid basketball player and at one time played against former Portland Trail Blazer player and current Mizzou (University of Missouri—Gov. Nixon’s alma mater) basketball coach Kim Anderson.
“I know Kim from college. I went to Missouri and got a chance to see him there. I was a student at the same time. I have the odd sports anecdote of, right after he was cut by the Portland Trail Blazers, the next place he showed up was a city-league game in Columbia, and I had to guard him. I was not at NBA level—let’s put it that way—and it became relatively obvious.” – Gov. Nixon to Joe Walljasper, Columbia Daily Tribune
Gov. Nixon’s office did not disclose more details about his two-for-one surgery—such as location, surgeon or prognosis.
Although a recent study has found that patients with inflammatory arthritis who underwent same-day bilateral knee replacements had the same outcomes as patients with osteoarthritis (OA). Which should be good news for the Governor.
Mark Figgie, M.D. of the Hospital for Special Surgery in New York described his recent study of bilateral knee replacements to OTW, “Since inflammatory arthritis is a systemic disease, patients have historically had poorer outcomes, including higher complication rates. We wanted to see if our results with bilaterals in carefully selected patients were comparable to patients with OA; I was pleasantly surprised at results showing that the outcomes were no different in patients with OA. I expected those with inflammatory arthritis to have higher complication rates, more prolonged hospital stays, and more transfers to a rehab facility.”
“The inflammatory patients are in many ways in better shape when they come to us. What we see with OA is patients who are sicker and more obese; in inflammatory arthritis, because the disease is treated more aggressively, they are often in better condition. However, those with inflammatory arthritis tend to have more severe contractures and joint deformity. If both knees have bad contractures, you should do both knees the same day because if one knee is straight and the other is contracted then the patient won’t rehab properly. This study shows that orthopedic surgeons can take on these patients with difficult deformities and get good results.”
The press reports that Gov. Nixon is in contact with his staff and is continuing to serve in his administrative role while he recovers. His staff has indicated that the surgeries were not done because of any recent injury.
This wear and tear is clearly patient generated and in the service of the great sport of basketball.
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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