Should You Have Knee or Hip Replacement Surgery?

Joint replacement used to be called "high-tech," but it's now a common operation. Doctors replace more than a million hips and knees each year in the U.S., and studies show the surgeries ease pain for most folks and help them get around better.

"Joint replacement can be a life-changing procedure for the right patients," says Tariq Nayfeh, MD, PhD, assistant professor of orthopedic surgery at Johns Hopkins Bayview Medical Center in Baltimore, "but it won't help everyone with hip or knee pain."

To find out if a new joint is right for you, weigh the pros and cons of surgery and think carefully about the rehab you'll need to do when the operation is over.

Reasons to Replace Your Hip or Knee

You may want to consider hip or knee replacement if some of these things are true for you:

Pain and stiffness. It may be time for a new joint if it hurts so much that it's hard to walk, climb stairs, get up from a chair, or do other activities.

The pain is also long-term, lasting at least 6 months, says Matthew Austin, MD, an orthopedic surgeon and spokesman for the American Academy of Orthopaedic Surgeons.

Affects your daily life. It's not just pain itself that matters, but the impact it has on your regular routine, Austin says. Do your joint problems limit what you can do? Does it cause your mood to change?

Bone damage. X-rays and other imaging tests show that your osteoarthritis or other conditions are taking a toll on your joints.

Other treatments don't help. Medication, injections, or devices like walkers aren't giving you the relief you need.

Deformity. Your knee is severely swollen or your leg is bowed.

When Joint Replacement May Not Help

Infection. "The No. 1 reason to avoid a joint replacement is recent infection anywhere in the body," Nayfeh says. It could spread to the area of the joint immediately after surgery or months later and cause serious problems, including joint complications that need more surgery.

Other health problems. If you have a history of heart attack, stroke, or now have diabetes that's out of control, you may be at risk for complications from surgery. Also, if you're obese you may need to lose weight before you get a joint replacement.

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Not sure why you hurt. Your surgeon needs to be certain that the pain you feel is really caused by joint damage and that a new hip or knee will help.

"People can have pain that feels like joint pain, but the scans don't seem to show damage in the joint," Nayfeh says. There are lots of reasons for severe pain in the knee or hip -- such as nerve damage -- but a joint replacement won't help.

Pain when you're still but not when you move. "Joint replacements are well established for treating pain that gets worse when walking," Nayfeh says. "But people who only have pain while at rest seem less likely to benefit."

Things to Consider

Even if you meet the requirements for joint replacement surgery, ask yourself three key questions:

Could another treatment work? Joint replacement is a relatively safe procedure, but it does have risks, and full recovery takes months. Make sure that you've tried nonsurgical treatments first.

Do you have help at home? It's not easy to recover from joint surgery when you're living alone. For at least a few weeks, you'll likely need some help to get dressed, prepare food, change your bandages, and move around. If you don't have family or close friends who can pitch in, see if there's a rehab place where you can recover.

Are you willing to make changes? To get the best results, you need to commit yourself to hard work in the months before and after surgery. You may need to improve your lifestyle, eat healthier, quit smoking, lose weight, and exercise more.

"I tell people that when it comes to a successful joint implant, 10% of the success lies with the surgeon, 10% with the surgery, and 10% with the physical therapist," Nayfeh says. "The rest is up to the patient. If they don't work at recovery, they don't get better."

Next Steps

Here's how to organize your decision-making process:

Do your research. There are a lot of types of joint replacements, so read up on the different methods. Check out trustworthy web sites, like the American Academy of Orthopaedic Surgeons (AAOS) or the American Association of Hip and Knee Surgeons (AAHKS), Austin says.

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Talk more with your doctor. Learn the specifics about how an operation would help and what recovery is like. Ask how much experience your surgeon has with hip or knee replacement.

Get another perspective. "I think anyone considering a joint replacement, or any major surgery, needs at least a second opinion," Nayfeh says.

Consider the impact of surgery and recovery on your life. Think about how it would affect your job or your home life. Talk to members of your family about whether they could help out during recovery.

Don't rush yourself. When deciding whether to get joint replacement surgery, take your time. Make sure you have answers to all your questions before you make up your mind.

WebMD Feature Reviewed by James Kercher, MD on June 12, 2016

Sources

SOURCES:

American Academy of Orthopaedic Surgeons: "Preparing for Joint Replacement Surgery," "Total Knee Replacement," "Activities After a Knee Replacement."

Tariq Nayfeh, MD, PhD, assistant professor, orthopedic surgery, Johns Hopkins Bayview Medical Center, Baltimore.

Matthew Austin, MD, spokesman, American Academy of Orthopaedic Surgeons; orthopedic surgeon, Rothman Institute, Philadelphia.

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