MOLINE, Illinois — When Mike Nightingale of Orion, Illinois was just five months into his retirement, he started getting a lot of pain in his knees. It was that pain that prompted an appointment at ORA Orthopedics, but his journey was just beginning.
"It was like someone kicked me in the gut, I didn't know what to do, it was very painful to walk," said Mike Nightingale, 69. His doctor told Nightingale he had deterioration of the meniscus in both knees. The retired maintenance electrician would have to have a double knee replacement. The only other alternative - a wheelchair.
But there was a problem, Nightingale was overweight at 300 pounds. That extra weight adds to the risk of complication.
"As his doctor, I had to look at him and say, 'Do you want your operation done with the risks modified in your favor? Or do you want to do your operation when the risks are high?'," said Dr. Steve Boardman, Orthopedic Surgeon at ORA Orthopedics.
Dr. Boardman and Nightingale worked together to create a weight-loss plan.
"It took a lot more work on his part than mine and now he’s had two successful knee replacements," said Dr. Boardman.
Motivated by sheer pain, within three months, Nightingale got his BMI down to 40. His right knee would be replaced on February 19, 2016.
"That was strictly by Dr. Boardman, he said which one do you want to do first? I said the right one, it hurts the worst!" said Nightingdale.
Recovery, rehab and eight months later, Nightingale got his left knee replaced in October, 2016.
"It’s gratifying to see a patent take responsibility and do what it takes to make their own risk optimized in their own favor," said Dr. Boardman of Nightingale's efforts to lose the weight required for surgery.
Now, three months after his latest knee replacement, Nightingale continues to work on building strength in his upper legs by working out at his local YMCA about three times a week.
"[Nightingale]'s done well. He's getting back to the things he wants to do - including flying his airplane," said Dr. Boardman.
Both Dr. Boardman and Nightingale enjoy flying airplanes as a hobby - it's something that brought the two together as friends prior to their patient-doctor relationship.
"It’s a privilege to take care of a friend, even though there were some prerequisites that we asked him to take care of before we do the operation," said Dr. Boardman, referring the weight that Nightingale had to lose before going under the knife.
Dr. Boardman says he pushes harder than other doctors to come up with some absolute requirements for patients before surgery happens in order to bend the complication rate.
"It’s hard to be at the beginning of a change where we’re asking patients to do more," said Dr. Boardman.
Dr. Boardman says that the medical community has gone nearly as far as it can go to improve outcomes, lower infection rates, improve durability and make operations turn out well.
"Complication of infection of a total joint is a terrible thing for a patient to go through and it’s costly," said Dr. Boardman, adding that weight influences infection rate probably more than anything.
When a patient loses weight before surgery, he or she lowers the rate of complication.
"It’s gratifying because I wouldn’t have people like Mike Nightingale in my practice," said Dr. Boardman. "I wouldn’t see that outcome if I wasn’t able to push a little more."
Every year in the United States more than 600,000 knee replacements are performed, according to the American Academy of Orthopaedic Surgeons.
"I was able to climb directly into my airplane," said Nightingale. "For me that was the culmination of both legs being redone - not only being able to get around on a daily basis, but to use my airplane."
Nightingale says with certainty, his motivator to lose nearly 80 pounds was pain. He also got to go off his blood pressure medication after losing the weight.