At a certain point in the aging process, you may notice your joints getting a little stiffer and you may start to wonder if a joint replacement is in your future. The procedure is common and has helped millions of people overcome the disabling effects of arthritis, but how do you know when the time is right?
The most common reason for replacing the knee or hip joint is the progression of arthritis, where the cushioning cartilage between the bones in the joints deteriorates and causes pain. Injuries to the joint can also create a need for joint replacement.
Knees are the most commonly replaced joint, with more than 600,000 surgeries performed every year, according to the American Academy of Orthopaedic Surgeons. Approximately 300,000 hip joints are replaced every year.
“We frequently see people in their 50s and 60s who come to us complaining of ongoing joint pain,” says Dr. Kelli Baum, from Samaritan Medical Group Orthopedics in Albany. “As pain begins to impact a patient’s quality of life, we start with more conservative treatment options to help them feel better.”
Some conservative measures that help with pain and daily living activities include injections, anti-inflammatory medications, weight loss, physical therapy and lifestyle interventions.
Once conservative treatment options have been exhausted, joint replacement surgery can mean an improvement in overall pain and function and an increased quality of life.
Deciding when to have a joint replacement surgery is a little like being Goldilocks — you don’t want to have it too soon or too late; you’re looking for “just right.”
“The right age for knee or hip replacement is different for every patient. It ultimately comes down to how a patient’s arthritis is affecting their quality of life,” says Dr. Baum.
Artificial joints are very durable and designed to last for a long time, but they won’t last forever. A study published in the Lancet found that nearly 90% of hip replacements lasted 15 years, while 58% last 25 years. For total knee replacements, 93% lasted 15 years and 82% lasted 25 years.
The right time?
That is a question for you, your family and your orthopedic surgeon.
“We take into consideration overall health, activity level, weight, age and quality of life, in addition to how long a new joint should last,” says Dr. Baum.
Other considerations Dr. Baum discusses with joint replacement candidates include:
• How much does joint pain or stiffness affect you and your quality of life?
• How much pain do you have while resting and not using the joint?
• Is there a physical deformity around the joint?
• Is your hip or knee pain limiting your ability to do activities you enjoy?
If you are having severe pain and are unable to do daily living activities, joint replacement surgery may still be the right choice even for younger patients, says Dr. Baum.
Should you delay?
If you’re in your 60s, is there a reason to continue putting off surgery?
Research published in the journal Geriatric Orthopaedic Surgery & Rehabilitation found that of nearly 1,800 patients who had total hip replacement or total knee replacement surgery, complications in the hospital and the likelihood of needing to be placed in a skilled nursing facility after surgery increased with age. Long term outcomes were similar across all age groups.
“There is some evidence that having surgery before advanced age has an easier recovery with less chance for complications,” says Dr. Baum. “We don’t encourage having surgery before it’s necessary, but when a patient is a candidate for joint replacement and has pain that affects their quality of life every day, there is no reason to delay.”
Worries about the cost, fear of surgery and the process of recovery, or the timing of life events like taking care of elderly parents or a planned vacation, can lead people to delay surgery.
Dr. Baum reports that the pain of waiting too long can severely impact quality of life and activity levels, making it harder to recover after surgery.
“Once indicated, I encourage patients to schedule surgery when they are ready,” she says. “This gives people the ability to prepare for the recovery process. If a person is stressed about missing a major life event because of surgery, their recovery can be compromised. I want them to be ready both mentally and physically, so the timing of joint replacement is largely up to them.”.”
According to Dr. Baum, patients overwhelmingly report improvements in pain and function after the procedure.
“Joint replacement is a big decision and the recovery process can be long. It requires hard work and dedication to healing, but the vast majority of patients experience significant pain relief and a return of their quality of life,” says Dr. Baum.
Kelli Baum is an orthopedix surgeon for Samaritan Health Services. She specializes in joint replacement surgery
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