What Do You Need to Know about Joint Replacement?
Arthritis is a condition that impacts the daily lives of millions of people. There are many different types of arthritis, but they’re connected by a common thread: they all cause some kind of discomfort or pain.
In the case of osteoarthritis, which is the most common form, the pain comes from the cartilage between bones wearing away. Cartilage is a living structure that coats the end of the bone, and over time, that molecular structure can break down. When it does, a patient is often left with bone-on-bone contact, which can be very painful.
The knees, hips, and shoulders are particularly susceptible to this wear and tear. While some discomfort in those areas can be tolerated, pain that prevents you from living your life should be addressed by a medical professional. For some people, addressing that pain comes in the form of a joint replacement performed by an orthopedic surgeon.
Most people are familiar with the concept of joint replacement surgery, but there are plenty of common questions and misconceptions about the procedure. In an effort to answer some of those questions, I participated in a Facebook Live as part of our One Healthy Boston partnership with WCVB-TV as part of National Arthritis Awareness Month.
The session featured some great questions that I’ve answered below in an attempt to help patients be more informed about joint replacement.
How do I know if I’m a candidate for joint replacement?
Aches and pains are a fact of life, whether they’re found in a joint, a muscle, a nerve, or anywhere else. With joint pain, however, most patients reach a point where the pain starts to really affect their quality of life. This is the point where treatment options should be discussed with your doctor.
However, it’s important to note that joint replacement surgery isn’t the first step. Quite the opposite, actually!
Joint replacement surgery is a last resort, something that should only be considered once you’ve explored all other avenues of treatment.
Your specific treatment plan will come from your doctor, and will be individualized to your unique case. Some common initial remedies include over-the-counter medication, exercise, weight loss, and discontinuing aggressive activities. These are all things that can help ease pain in the joints. If those treatments prove unsuccessful, there are invasive procedures, including injections or arthroscopy (which is a smaller surgery), that can be helpful as well.
If the above treatments offer no relief, a patient becomes a good candidate for joint replacement surgery. As you can see, however, there is a significant work-up involved. Patients shouldn’t jump right to surgery from the beginning.
Are there age limits for joint replacement surgery?
This is a common question on both ends of the spectrum: patients worry about being both too young and too old for surgery. There’s no right or wrong age for joint replacement. Candidacy for joint replacement focuses on the condition of your joints and the treatment you’ve had thus far, not your age.
For example, I wouldn’t discriminate just because a patient is 58 years old. You could be 58 years old with end-stage arthritis, so your quality of life is being affected. If you’ve exhausted all non-operative means and you have an x-ray that shows advanced arthritis, you’re a candidate for joint replacement.
When we do joint replacements, we like to evaluate the patient outside of his or her age. If the patient is active enough and suitable enough to have the surgery, then he or she should have the surgery. We don’t age discriminate on either side.
How should I prepare for an upcoming joint replacement procedure?
As with many things in life, going into something with as few surprises as possible is the best way to approach it. We like to have patients prepare by having them become educated on what they’re going to experience. This includes knowing what to expect before the surgery, during the surgery, and after the surgery.
Most organizations that perform joint replacement surgeries will have some kind of class for patients, and we encourage all of our patients go to the class before their procedure.
We also ask patients to make sure they’re prepared for their return home after their surgery, mainly to ensure that they don’t have any trouble getting around the house. We encourage you to take a close look at your home and to remove things like rugs, power cords, and items on stairs or in hallways that may make mobility more difficult.
By taking the necessary steps before the surgery, patients are far more likely to have a positive experience and a speedy recovery.
What should I expect in the hours and days after my joint replacement procedure?
Most patients will go home one or two days after surgery; it’s becoming rarer to have patients spend three days in the hospital.
Today’s joint replacement procedures benefit immensely from new techniques with pain relief and local pain injections around the surgical site.
In fact, most of our patients are up walking the night of their surgery! They’re able to do things like get up and go to the bathroom on their own after the procedure, and things like that build confidence.
However, it can be a bit of a honeymoon period: once that local medicine wears off, there can be a little more pain. By that time, we usually have our patients on a balance of medicines that will help. This isn’t to say they don’t have pain — it’s a painful operation for a few weeks, but there is definitely a lot of motion and progress early on.
For patients who have done a little preparation, like making sure their home is all set and ensuring they have a family member or friend around to help them if needed, the best place to go after surgery is home. In some cases, a patient may have medical or social reasons that require a stay in a skilled nursing facility, but those situations are happening less and less.
For the first week or so after joint replacement, the physical therapy is basically just motion. We want people to get up and walk, as that’s a good way to avoid complications. Things like lifting weights or more intense exercise can wait.
People will usually do well within a few months after joint replacement, but a lot of patients make more strides after the first year. Sometimes, recovery isn’t instantaneous. It can take a little bit of time for people to get accustomed to their joint and for all of the swelling to go down. People are different: some get better quickly, and for others it takes longer.
We preach patience, and usually tell people that within a year, they should be making their maximum improvement.