By 2030, nearly 3.5 million Americans will undergo total knee replacement surgery every year, and more than half a million will get total hip replacements. The vast majority of these surgeries are performed on people with osteoarthritis (OA) that has not responded to standard OA treatment.
Joint replacement or other surgical procedures 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 alleviate 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.
Just because your arthritis is severe enough to warrant joint replacement surgery, however, does not mean you are 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 undergoing surgery, which will both 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 undergoing joint surgery.
- Heart, lung, or kidney disease. Having these conditions may make the use of anesthesia for surgery risky.
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.
The vast majority of people who undergo 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:
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 increasing your mobility
- 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 one year later compared with people who did not have the surgery.