Is It Time for a New Joint?

Millions of us struggle with pain and loss of motion because of joint damage caused by arthritis. If other treatments fail to offer relief, you may wonder about turning in your worn-out joints for new ones.

Although you shouldn't consider this surgery as your first treatment option, if you are a candidate for joint replacement, the results will likely please you. The results of the surgery—called arthroplasty, or total joint replacement—are good to excellent for more than nine out of 10 patients, says Gordon M. Aamoth, M.D., an orthopedic surgeon in Minneapolis. They get relief from pain and can resume normal daily activities.

Joint replacement surgery is fairly common for people with osteoarthritis. In this most common form of arthritis, cartilage—the tissue that protects bones in a joint—breaks down and wears away. Bones rub together, causing pain and loss of motion.

Should you have surgery?

Dr. Aamoth says joint replacement should be a final step in treatment. "We've become accustomed to getting instant relief," he says. "Sometimes people ask for surgery before they give other treatments a chance."

Those other treatments include using pain medication, losing weight to ease stress on the joint, and reducing physical activities that cause pain. Doctors also may suggest exercises to keep muscles and joints flexible, promote fitness, and strengthen muscles that support damaged joints.

Generally, a candidate for surgery should be older than 60, but certain younger patients also can have joint replacement surgery. Younger patients may have other options, such as changing to less physically demanding jobs or having less extensive surgery to realign or partially replace joints.

The younger you are when you get a new joint, the more likely you are to need corrective surgery later. Surgery to fix or replace artificial joints has a risk of infection and other complications about four times greater than the initial surgery, says Ramon Jimenez, M.D., past president of the California Orthopedic Association and a member of the board of directors of the American Academy of Orthopaedic Surgeons. Because doctors shape and remove bone to accept the new joint, repeated surgery also leaves less bone to attach to each new joint.

Dr. Aamoth says you shouldn't consider this surgery if you are prone to infection or can't tolerate anesthesia.

When do you need surgery?

X-ray evidence of joint damage is one of the criteria used to decide who should have this surgery, Dr. Jimenez says. It is not the only one, though. Dr. Jimenez says your symptoms—mainly pain—are more important.

Candidates for joint replacement surgery should have one of the following: severe pain during activity, such as walking or getting up from a chair; pain that prevents them from doing activities; or pain at night that prevents them from sleeping.

What can you expect?

To get ready, Dr. Jimenez says, you should work with your doctor to be sure you can tolerate anesthesia. If you have dental problems, have them corrected before surgery to reduce the risk for infection. Bacteria from the mouth can get into the bloodstream and cause an infection at the surgical site. Heart problems should be stabilized before surgery.

Total joint replacement involves a three- or four-day hospital stay. You'll receive an anesthetic for the duration of the surgical procedure. The surgeon will reshape the ends of the bones to accept the artificial parts.

Artificial joints are usually made of metal and hard plastic. Cement attaches plastic parts. Metal parts may be anchored by inserting a rod into the bone or with cement. Typical hip and knee patients can walk the next day using a walker. Dr. Aamoth says you'll likely be discharged on the third or fourth day, but you'll need time to rehabilitate.

At first, you may need crutches or a cane. Within a few months, you should resume most of your normal daily activities unaided. You may still need physical therapy.

After shoulder replacement surgery, you can start passive shoulder exercises, in which someone else moves the joint for you, soon after surgery. Three to six weeks after surgery, you'll perform exercises a therapist gives you. Eventually, you'll begin to stretch and strengthen your shoulder so you can regain normal use with far less pain than you had before the surgery.

Dr. Jimenez says most patients find the recovery process painful for two to three months. "But the pain is different than the arthritis pain they have been experiencing," he says. "And it's the kind of pain they expect to go away."

Will a new joint last?

Drs. Aamoth and Jimenez caution against unrealistic expectations for a new joint. You shouldn't expect it to tolerate activities that involve jumping or the kind of stress that would be hard on a natural joint.

"You can't play professional sports," Dr. Jimenez says. "But I tell my patients they can play doubles tennis as long as they don't try to be the hero and make the difficult shots."

In the past, Dr. Jimenez says, it was not clear how long an artificial joint would last. "Now we know it should last a good 10 to 15 years," he says. "So the recommendation is that if someone is 60 to 65 and needs a new hip, go ahead. There's not as much opposition as there used to be because in the long run it's more effective and less expensive than not having it done."

"The life of a joint depends more on mileage than length of time it is used," Dr. Aamoth adds. "Someone in his 50s is going to put more stress on the joint than someone who is older," so the person in his 50s "might be better advised to wait."

If you wait, you can expect a benefit. Research is focusing on better materials, such as all-metal and all-ceramic joints. Dr. Jimenez and Dr. Aamoth say that means better, stronger, longer-lasting joints will soon be available.