Neal Rubin

For boy, grandpa's surgery nothing to take for granted

Harold Jackson Jr. made it to age 83 with original parts, but last week the former automotive publicist went into the shop at Beaumont Hospital, Royal Oak for an aftermarket knee.

The operation was the proverbial success, and after a few days of lockdown at a rehab center, he's home in Bloomfield Hills getting to know his new hinge. The whole thing was a bit perplexing, though, for his 8-year-old grandson, who had an absolutely logical question after hearing that Grandpa had a knee replaced.

"What are they going to do with the old one?" Ryan asked.

Leave it to an elementary-schooler to bring out the wonder in something the rest of us have come to see as routine, or to not even think of at all.

Beaumont swapped out 2,400 hips and knees in 2008 and was in the Top 10 nationwide for Medicare joint replacements. What once seemed astonishing has become almost pedestrian, with some surgeons scheduling six or seven in a day.

But if a new knee is going in, what do they do with the old one?

Full of questions

Ryan Jackson, the middle of three sons of Brad and Beth, lives in Rochester. Today is his birthday, so if you see him, sing, or at least hum a little.

"He has a memory like an elephant," says Brad, 41. "He can remember things we told him just in passing in a conversation two years ago."

He tends, however, to remember them literally, or to take them that way at the moment. Six months ago, for instance, after Ryan's 96-year-old great-grandmother died in Texas, Beth was talking about how the body was going to be shipped north and buried in Detroit.

Ryan stopped her. "What," he asked, "are they going to do with her head?"

Beth assured him that it would also make the trip.

With the knee, says Harold, "I think he had in mind I'd walk out and show it to him." But that's not the way it works.

More like a trim

The knee, come to find out, largely stays put. What gets refurbished is the cartilage, the stuff that keeps bone from scraping painfully against bone.

"You're just cutting off the ends," says Craig Silverton, the division head of adult reconstructive surgery at Henry Ford Hospital in Detroit. Usually that means 8 mm or 10 mm apiece, not quite two-fifths of an inch, from the low end of the femur and the top of the tibia.

It's a matter of resurfacing the ends so that the plastic and metal joint fits on them. Even the kneecap winds up in its old stomping grounds, albeit with 8 mm shaved from the underside so it, too, can be glued into place.

Silverton, 57, has been wielding his vibrating saw for 20 years -- and to answer Ryan's question, the small amount of bone that gets lopped off winds up being tossed out with the hospital's other medical waste.

In the old days, Silverton says, a patient had to be at least 65 to get the operation, because the replacement knee doesn't last forever and it didn't seem sensible to repeat the process. The number has steadily fallen, and now some of the 250 procedures he'll do in a year will be on 40-year-olds.

"People are a little more demanding of quality of life at this point," he says. "They say, 'I'm active, I'm 40 or 45, and I'm not going to accept this disability."

Doggone good joke

Meanwhile, back with the Jacksons, Ryan's question quickly made the rounds of the extended family. Because aunts are allowed to be delinquents no matter how old they are, Brad's sister bought one of those beige rawhide dog bones, put it in a jar, and gave it to Ryan as an early birthday present from Grandpa.

"His mouth was open about 10 inches," Brad says. "He stayed a good 3 feet away from the thing."

Finally, before they brought the gift home and the family's Great Dane went after it, the grown-ups told Ryan what it really was.

"He felt a lot better after that," Brad says, and on the subject of feeling better, Harold reports that he's quite pleased with his new knee.

That's to be expected -- but it's OK to marvel at it, too.

nrubin@detnews.com (313) 222-1874