By 2030, nearly 3.5 million Americans will have total knee replacement surgery every year, and more than half a million will get total hip replacements. The vast majority of these surgeries are done on people with osteoarthritis (OA) that has not responded to standard OA treatment.
Joint replacement or other surgeries are sometimes considered the “treatment of last resort” for people with osteoarthritis. Doctors frequently tell patients to wait as long as possible before joint replacement, but to get the best results, it should also not be delayed too long. How do you know when it’s time to seek joint replacement surgery?
Ask yourself these questions:
- Can I still do the things I enjoy doing, like golfing, shopping, or playing with my grandchildren?
- Do the medications I take, and/or physical therapy, still ease the pain reasonably well?
- Can I sleep at night without waking up multiple times due to pain?
- Can I still do daily activities, like getting out of a chair, going up and down stairs, using the toilet, and getting into and out of the car without much difficulty?
If the answers to all of these questions are yes, then you probably don’t need to consider joint replacement surgery yet. On the other hand, if you answered “no” to most of them, then you should discuss joint replacement surgery as a possible option with your doctor.
Is Joint Replacement Right for You?
You might consider a joint replacement if you have symptoms in your knee or hip such as:
- Lots of pain
- Stiffness
- Limping
- Weakness
- Swelling
- Poor range of motion
- Problems walking or doing other everyday activities
If you have these problems, your doctor may suggest that you try physical therapy, medication, and other treatments besides surgery. If all those don’t work, the time may be right to think about getting a joint replacement.
The Benefits of Joint Replacement
With a new joint, you'll hurt a lot less, and you may even be pain-free. Depending on your age, you may be able to use your joint normally and move it around with a full range of motion. This should make everyday tasks like walking and household chores much easier.
In some cases, you may be able to start playing sports -- low-impact ones like golf or cycling -- that were impossible before your surgey.
Risks of Joint Replacement Surgery
Just because your arthritis is severe enough to warrant joint replacement surgery, it doesn’t mean you’re automatically a safe candidate for an operation. There are several conditions that may make joint replacement surgery riskier, including:
- Obesity. Your doctor may ask you to lose some weight before surgery, which will lessen the risks of surgery (such as infections, bleeding, and problems with anesthesia) and give your new hip or knee a better chance of success.
- Age. If you’re in your 90s, your doctor may discuss with you whether or not the risks of surgery are greater than the long-term benefits you may get from a new joint.
- Bone density. Severe osteoporosis needs to be considered before you get joint surgery.
- Heart, lung, or kidney disease. Having these conditions may make the use of anesthesia for surgery risky.
As with any procedure, you may have complications.
Bacteria can cause an infection. About 1 in 100 people who have a joint replaced get an infection afterward. It can show up right after the procedure or months or years later. And if you're obese or have diabetes, you may have higher odds of an infection.
In some cases, doctors can wipe out the infection using antibiotics. But they may have to do surgery again to replace an infected implant.
Deep vein thrombosis is the term for a blood clot -- basically, a clog -- in a vein that’s deep in your muscle or tissue. This clot can cause pain and swelling. It may also damage your vein. In rare cases, the clot might break free and cause a life-threatening blockage.
Joint replacement surgery can change the flow of blood in the deep veins of your lower body. Because of this, it can cause deep vein clots in some people.
In some cases, the bones around your joint may break or crack as a result of the surgery. Your doctor may need to operate again to fix these fractures.
A joint replacement gives you higher odds of joint dislocations. Also, the leg your doctor repairs may end up slightly shorter or longer than before.
Nerve damage is possible, which can cause pain and other symptoms.
You may need a second joint replacement surgery later on. Artificial joints don't last forever. Doctors usually say you can count on them for at least 10 to 15 years. Newer artificial joints may last longer.
Preparing for the Surgery and Its Aftermath
Before you consider surgery, you will also need to prepare for what comes afterward and have realistic expectations of how much improvement to expect and how much work you will need to do to get the best outcome. In the case of hip or knee replacement, your doctor may suggest doing the procedure robotically.
Recovery will involve some pain, which can last several months. You'll have to spend a few days or weeks walking with crutches or a walker.
Also, you'll need to do physical therapy and other exercises designed to help your new joint work well.
The vast majority of people who have joint replacement surgery experience dramatic reductions in pain and a great improvement in their ability to do everyday things like going to the store, cleaning house, walking around town, and engaging in light exercise like walking, swimming, ballroom dancing, and stair climbing.
But a joint replacement is not the original joint, and you can still have some restrictions on your activities. High-impact activities should be avoided for the rest of your life. Here are some activities that you should probably avoid after hip or knee replacement, but speak with your doctor first:
- Jogging, running, or skiing
- Playing football, basketball, soccer, and other high-impact sports
- Doing karate or other martial arts
- Jumping rope
- Taking a high-impact aerobics class
Your new knee or hip can last for more than 15 years, especially if you treat it well. But the more stress and strain you put on the joint, the sooner it is likely to wear out or become loose. Just as before you had joint replacement surgery, activities that put less weight on your joints, like swimming and cycling, are particularly good for exercising a new joint without overstressing it.
In order to get the most function out of your new joint, there’s a lot of hard work to be done right after surgery. You’ll probably be in the hospital for several days, and during this time, physical therapists will teach you the right kind of exercises to do to restore movement in the affected joints.
But after you go home, it will be up to you to keep up with the exercise program that your surgeon and physical therapist provide. A surgeon can put in the new knee or hip, but no one but you can exercise it. Before pursuing joint replacement surgery, you should commit to an exercise program that will include:
- Regular walking, first at home and later outdoors and for longer distance, aimed at gradually and safely making you more mobile
- Gradually resuming other normal daily activities, like standing, climbing stairs, and getting up and down from a chair
- Daily, regular exercises designed to strengthen the muscles around your new joint; after your physical therapist teaches you these exercises, you can often do them at home.
If you do all of these things, you are likely to have an excellent outcome should you choose joint replacement surgery. According to a study published in June 2008 in the Archives of Internal Medicine, older adults who had joint replacement surgery improved significantly on measurements of arthritis symptoms 1 year later, compared with people who did not have the surgery.
