Is joint replacement for you?

“Should I have my hip or knee replaced?” patients often ask me. Many people are confused about the long-term results of replacement surgery. And from some of the correspondence I’ve received, it’s apparent many people have unrealistic expectations of what they will be able to do following hip or knee surgery.

As a medical student, I witnessed one of the first operations for hip replacement performed at Massachusetts General Hospital. At that time, it was considered a major procedure, but today it’s almost routine.

Which may be why people talk of having their hip or knee replaced as if they were replacing the old tires on their car. But those who have the procedure soon discover it’s not quite that simple.

Joints wear out
Because we’re all living longer, our joints often wear out before the rest of our “parts.” Healthy joints are covered by a thick pad of slippery cartilage, which acts as a cushion protecting the ends of bones like shock absorbers on a car.

But this protective cartilage tends to wear out when a joint is overused or if too much pressure is put on it due to obesity. Conversely, cartilage can also be lost if you’re couch potato. Like any other part of the body, if you don’t use it, you lose it. Normal physical activity helps nutrients flow into cartilage to keep it healthy.

The loss of cartilage means bone grinds on bone-the surfaces of the bone become rough and the friction causes osteoarthritic pain.

Delay if possible
So how long should you put up with the pain? This is always a tough question because different people have different pain thresholds. Always ask yourself this question when contemplating an elective operation: is the problem and pain severe enough to warrant the risks involved in major surgery? If it is, then the time is right.

My advice is to delay surgery as long as it makes sense to do so. Hip and knee replacements don’t last forever. Replacements wear out anywhere between 10 to 20 years, depending on your weight, general physical health and level of activity.
Deciding to have this surgery too early may mean you will need a second or even a third replacement operation, and subsequent procedures are always more difficult due to scar tissue.

Other options
Not all patients with osteoarthritis need to have total hip or knee replacement surgery. Some patients can often be helped by arthroscopy. For this procedure, the surgeon makes several small incisions and looks into the joint with optical instruments. Rough areas of the bone are then smoothed and debris in the joint is removed.

Arthroscopy is more often performed on the knee than the hip and is best suited for people who don’t require total knee replacement. Patients who undergo this procedure can be discharged the same day of surgery and usually experience pain relief for several years.

Be realistic
Patients who decide to have either a hip or knee replaced need to have realistic expectations. Both procedures require extensive post-operative physiotherapy to strengthen muscles. There are no short cuts to restoring joint function. It requires a good deal of motivation and work to return a joint to even near normal mobility.

How soon patients return to relatively normal walking depends on several factors. Most people who have hip replacement surgery require two to three months of rehabilitation.

Those who have a knee replacement experience more post-operative pain, and the surgery normally requires three months of recovery and physiotherapy before patients can navigate well. And again, be realistic-your gait is never quite the same.

Dr. W. Gifford-Jones is the pen name of Ken Walker, MD, who practices medicine in Toronto.