Joint Replacement and Your Health and Well Being
Joint replacement is indicated for patients who are experiencing intolerable pain and problems with daily functioning. In other words, they have end stage arthritis. The X-rays of this type of arthritis usually show “bone on bone”. We all want to maximize our health and well-being so a common question from these patients is “When should I have joint replacement?” and “What will happen if I wait?”
Joint replacement surgery is one of the largest line item expenses for Medicare but one of the most successful and cost effective surgeries performed in the United States. It provides pain relief for the patient and adds net revenue to the economy with improvements in function and income earning potential. It can contribute greatly to a patient’s well being but not to their health. So how do we decide if or when we should have a joint replacement?
Replacing a joint is different than most surgeries. In contrast to most of the medical treatment we receive, joint replacement will not improve our health or prolong our lives. If you think about why we get vaccines, take medicines and have surgery, it is to prevent or cure a disease. These diseases can adversely affect our health and therefore our well being. Pain in our joints is rarely a sign of a life threatening condition. Pain anywhere else in our bodies raises a concern for possible serious health conditions.
So how do you decide when to have a joint replacement? After all most other medical treatments have to be obtained in a certain time frame to be effective or the disease will get more difficult to treat or become untreatable. We usually have to make a decision about treatment that will make us healthy again or prolong our life. If we delay treatment we may miss an opportunity for a cure or shortened disease process
For example if you develop a pain in your abdomen and start getting sick you may go to an emergency room. Suppose a diagnosis of appendicitis is made. The surgeon will tell you that if you don’t have surgery you have a 10 times greater chance of dying or becoming much sicker. He will also tell you that the longer you wait the worse your outcome will be. So for most people the decision is made for them. A similar scenario, but maybe not as dire, will unfold for people who are told they have cancer, an infection or even medical conditions like high cholesterol, high blood pressure, anemia etc.
Pain is the number one criteria for deciding when to have a joint replacement. It is not based on how stiff the joint is or how much noise it makes or whether it is swelling. All of these symptoms are secondary signs of arthritis and are symptoms we can usually live and function with if it does not hurt.
End stage arthritis gets more painful and stiff but never becomes untreatable. No matter how painful, stiff or noisy a joint gets it will not threaten our health directly. Our modern techniques and specialized equipment allow an orthopedic surgeon to correct significant deformities and stiffness. If you decide to put off the surgery and you follow up with your surgeon he or she will tell you if deformity and stiffness progress such that it would compromise the outcome with further delay. Rarely does this happen. But your surgeon can’t tell you if the pain is too much.
Pain that interferes with daily function is the standard we use to judge the impact of the arthritis. Criteria we assess are when it gets difficult to walk or every step hurts, it is difficult to go up stairs and you need a banister, when you need arms on a chair because it is difficult to get out or especially if it wakes you up or keeps you awake.
So if we know that pain and dysfunction tell us when to have a joint replacement why not just have it? If we know that arthritis is incurable and it slowly progresses despite the best of modern medicine why not have it as soon as the diagnosis of arthritis is made? That way you won’t have to experience the pain and you can get ahead of it. But joint replacement is not a benign procedure. There are risks to be weighed against the benefits of the procedure.
There are risks with the anesthesia and early and late complications with the surgery. The risks rates are very low but the risks are very real. Anesthesia risks can range from nausea to serious heart and lung complications. The surgery can result in issues such as bleeding, pain, blood clots, infection, fracture and dislocation. Long term complications can include infection, loosening incomplete pain relief and failure of the components. So basically it is best to wait until your life is miserable from pain.
A good analogy is to think of it like a dirty car that needs to be washed. The dirtier the car gets the better it looks when it is washed! The worse the joint pain is, the more you will appreciate the surgery and you are much more willing to accept the risks of the procedure. We know a patient is ready for surgery when they come in and say “Doc, I don’t care if you cut it off!” or “I don’t care what you do, just make it stop hurting”.
The operation has improved over the years. The risk rates have decreased and the results have improved along with the technology. Many joint replacements can be performed as same day surgery allowing the patient to sleep in their own bed that night. The surgery is not a life saving but a life style saving procedure. It does not improve our health but it does improve our well being. It is an excellent choice when all else fails. So the best advice on when to do it is to realize you’ll know when it is time.
Dr. D’Angelo is a senior partner in Bluegrass Orthopaedics with specialty training in adult joint reconstruction of knees and hips. He has also been fellowship trained in arthroscopic (minimally invasive) joint surgery as well. He has performed thousands of knee and hip surgery procedures. He has an interest in performing minimally invasive surgery such as the anterior approach for hips and partial knee replacement as well as developing techniques that minimize post-operative pain and for rapid mobilization and rehabilitation. To learn more about Dr. D’Angelo and his team, please visit here!