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Published: Monday, 8/29/2011

Joint-replacement surgery: why and when to have it

BY DR. JOSEPH ASSENMACHER
SPECIAL TO THE BLADE
Dr. Joseph Assenmacher, ProMedica Physicians. Dr. Joseph Assenmacher, ProMedica Physicians.
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This is one of a series of columns about health issues written by staff members of ProMedica, Mercy Health Partners, Toledo Clinic, and the University of Toledo Medical Center, the former Medical College of Ohio.

If you experience joint pain, you know how easily it can slow you down and prevent you from enjoying movement. Sometimes, the pain is the result of a single, recent event, such as an injury. But if the pain lasts longer than expected or if it is a chronic occurrence, there might be an underlying problem.

When to see a specialist

Most joint pain can be adequately treated by your primary care physician. He or she will try conservative measures to relieve the pain and improve function. These treatments might include physical therapy, anti-inflammatory medications, cortisone/viscosupplementation injections, and alternative treatments such as acupuncture. When these treatments are not effective, your doctor might refer you to a specialist, an orthopaedic surgeon.

Orthopaedic surgeons specialize in diagnosing and treating bone and joint conditions. After learning your health history, knowing your activities and taking any needed X-rays or tests, your orthopaedic surgeon will help you determine a plan for treatment.

When to consider surgery

Many factors play a role in the decision to have joint-replacement surgery. Your overall health status, quality of life, response to conservative treatment, and age all play a role in the decision.

Timing, too, is extremely important. If the joint is replaced early in life or in an obese patient, the life of the replacement might decrease due to the higher demand placed on the joint. This might lead to future surgeries and an increased risk of complications. If the joint is replaced late in life, medical issues associated with aging may also increase risk and complications.

For these reasons, there is no exact answer on when to have joint-replacement surgery. Orthopaedic surgeons must look at each case individually to determine its need and success. As a general guideline, it is best to wait until the joint pain is intolerable and the arthritis has not progressed into a severe bone deformity such as bowleg or knock-knee. However, with current technology, there is usually a suitable option for patients at any stage of a joint problem. Even those who weren’t a candidate in the past are now able to have joint-replacement surgery.

Surgery recovery

Total hip and knee replacements are the most common types of joint-replacement procedures. Last year, there were more than one million total hip and knee replacements. They also are two of the most successful procedures in all of medicine. Ninety percent of patients would have their surgery again given their current outcome and nine out of 10 patients have not had another surgery on their joint replacement in 20 years.

Recovery after surgery can be helped by pain control with a regional anesthetic. A physical therapist also will help ease you into movement and strengthen supporting muscles. Overall, your motivation and desire to recover makes the biggest difference after surgery.

More information

If you are considering surgery, talk with your doctor about the risks associated with the procedure as well as current outcomes of the implants that are being placed. Web sites such as the American Academy of Orthopaedic Surgeons (AAOS.org) and Arthritis Foundation (arthritis.org) also are helpful resources for more information.

Dr. Joseph Assenmacher is an orthopaedic surgeon with ProMedica Physicians. For more information, please visit ppgdocs.org.



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