by: Kathleen A. Hogan, MD
As a specialist in joint replacement, I am frequently asked “How will I know when it is time to have my hip or knee replaced?” As we age, most people experience intermittent pain in their joints, usually worse with activity. Sometimes this pain is due to arthritis, but there are many other causes of joint pain. A few of these causes include muscle pain, stress fractures, tendonitis, fibromyalgia, Lyme disease, and inflammatory conditions. Arthritis is caused by damage to the cartilage of a joint. Pain from arthritis is the result of the inflammation this cartilage damage generates. Arthritic pain is often intermittent. If you have arthritis it is likely that you will have good and bad days. You may feel worse with changes in the weather. X-rays may show loss of cartilage and development of bony deformities.
Not all patients with hip and knee arthritis will need joint replacement surgery. Some patients have x-rays which show they have terrible arthritis and yet they continue to be active. Symptoms of pain and swelling can often be treated with anti-inflammatory medications and corticosteroid injections. Improving muscle strength can help reduce stress on the joint. Canes and walkers can be used to decrease the force of body weight on the joint. Weight loss can be especially beneficial as you place forces of up to 5 times your body weight across your knee joint during stair climbing.
Most of my patients with arthritis want me to tell them if they are ready for a joint replacement. My response is that you will tell me when you are ready for surgery. Only you know if the discomfort and pain that you experience is bad enough to have a major surgery. Does your knee or hip hurt you every day? Does your arthritis pain keep you from doing things that you enjoy? Keep in mind that joint replacement does not give you back the knee or hip you had when you were 20 years old. This is an artificial joint made of metal and plastic. It will feel better than your arthritic joint but different than a normal one! The majority of people who have their hip or knee replaced are happy with the results and feel that they “have been given their life back”.
Joint replacement surgery is not without risks. Although complications are rare, they can and do occur. When your arthritis pain can no longer be improved with other treatments, the benefits of surgery – relief of pain, improvement in mobility, increased function – far outweigh the risks. No one should feel they were “talked into” having joint replacement surgery by their surgeon or even by a family member. Deciding to go forward with joint replacement surgery is a decision which will have a major impact on the rest of your life, and it needs to be your decision.