When Should I Get My Joint Replaced?
By Mercedes von Deck, MD
As an orthopaedic surgeon, I’m asked questions about joint replacement all the time - but the answers I give are often different for different people. While x-ray images help guide me, they rarely tell the whole story. Everyone should be able to move without pain, but everyone’s life is different and each person has different expectations for mobility.
I usually tell people they should have their hip, knee or shoulder replaced when the pain and/or stiffness interferes with the things they need or want to do. It is definitely a shared decision between the patient, the physician, and sometimes the family.
People perceive pain differently. Sometimes x-rays show severe osteoarthritis, but the patient is functioning pretty well. Sometimes patients have a lot of pain and the x-rays don’t look too bad. In that case, we look for other sources of pain, such as referred pain, soft tissue injuries, or sometimes back issues.
Some people can also manage pain for quite a while without surgery. They may cut back on activities to reduce pain. I often ask someone how much they actually walk and people are sometimes surprised to see how sedentary they have become.
Physical therapy can also help in many cases. Bracing can help some people. Tylenol and nonsteroidal anti-inflammatories like ibuprofen or naproxen can also decrease pain but sometimes carry risks, especially for people with diabetes or kidney disease.
When pain relief from oral medications and ointments isn’t enough, we can try a variety of injections. The most common is perhaps a cortisone (steroid) injection and many people find these very helpful for a while. Other options for the knee include hyaluronic acid injections. These are sometimes known as “gel” injections and are approved only for the knee (and some insurances don’t cover them).
You may have also heard about “orthobiologic” options like platelet-rich plasma (PRP) or stem cells. These involve drawing blood or getting stem cells from your fat cells and injecting them into the joint. None of these are approved by the FDA and insurance will not cover the cost. There is also limited research showing they are effective for pain relief.
The bottom line is that none of the current injections cure arthritis. They may not help the pain and even when they do, the relief is limited. Patients often get tired of repeated injections and decide to proceed with surgery.
So why do so many people have arthritis? Is arthritis inevitable as we get older?
I do see patients in their 80’s and 90’s with normal looking x-rays, and while I love seeing this, it’s not the norm. As people get older, wear and tear on the joints leads to arthritis.
We also see people who have had an injury to a joint, damaging the cartilage cells. Over time the cartilage wears away, and arthritis shows up earlier than expected. Genetics can also play a role. Being overweight puts more force on the joint and can be a factor.
How old is too old to have a joint replacement?
I have replaced the joints of people in their 90’s. The best candidate for surgery at this age has to be relatively healthy, and your medical doctor has to check to make sure you could withstand the anesthesia and the surgery. This is actually true of everyone getting a joint replacement, but especially important for nonagenarians.
Some people wait too long. I have patients that chose not to have surgery in their 70’s come back when they are 90 and have too many medical problems at this point in their life.
Studies also show that people recover more quickly when they have some degree of physical fitness. If you are spending all your time on the couch because your knee hurts, you may have a harder time recovering your strength and stamina after surgery.
How young is too young?
We do try to postpone surgery in people under 60, but more and more people in their 40’s and 50’s are developing severe osteoarthritis. Some conditions, like juvenile rheumatoid arthritis, can even lead patients to have joint replacements as teenagers.
The main concern is that the joint replacement may not last your lifetime if you are young. Fortunately, technology is helping joint replacements last longer and longer. However, there are cases where the first joint replacement has to be replaced again. This is why we often wait if we can.
But if you really can’t do the things you love to do because of a painful joint, and you have tried non surgical treatments and still have pain, it may be time to replace your joint.
It never hurts to discuss it with an orthopaedic surgeon. Especially one who is willing to take the time to understand your needs and your lifestyle.