Hips Archive

Ask the doctors

Q. I'm in my early 50s and am considering a knee replacement for severe arthritis. I've heard that doctors typically encourage people to wait until after age 60 to perform this procedure. Should I wait to have the surgery?

A. Doctors do sometimes recommend that people under age 60 wait to undergo a knee replacement procedure, because these artificial joints typically last only about 15 to 20 years. If someone younger gets the procedure, it's likely that the joint will need to be replaced again down the line. That said, the decision to have a joint replacement really depends more on your individual circumstances, such as how much pain you have, whether the problem is causing you significant disability, and your overall health, not just how old you are. Some people can safely wait until they are 60 to undergo the procedure without a problem. For others, waiting too long to have the knee replaced might not be advised. For example, if the knee joint deteriorates too much, that may make the surgery to replace it more challenging. Over all, most people (80% to 90%) who do opt for a knee replacement are happy with the results of the procedure, but it's best to discuss the pros and cons with your doctor.

An ailing knee or a hip can make life miserable. Even if your doctor recommends it be replaced, you need to carefully weigh the risks and benefits before agreeing to this major surgery and understand that it will require significant rehabilitation to get back on your feet.

The most important factor in choosing to have a knee or hip replaced is how much it hurts and how much it is affecting your life. Here are six signals that it's time to have a knee or hip replaced:

The first line of treatment for many knee and hip problems includes taking over-the-counter pain medications. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are the most common pain medication options. However, these pain medications have a variety of side effects, so it's important to discuss your personal health risks with your doctor when considering long-term use for chronic conditions such as osteoarthritis.

Acetaminophen (Tylenol and other brands) is usually effective for mild pain and is easy on the stomach. However, it is toxic to the liver at high doses. The recommended maximum per day is generally set at 4 grams (4,000 milligrams), which is the equivalent of eight extra-strength Tylenol tablets. But that dosage can still cause liver problems for some people. To be safe, aim for 3,000 milligrams or less, and be cautious of mixing multiple products containing acetaminophen, such as a pain reliever and a cold medication or a prescribed narcotic.

Strength training is good for just about everyone. It's especially beneficial for people with arthritis. When properly done as part of a larger exercise program, strength training helps them support and protect joints, not to mention ease pain, stiffness, and possibly swelling. Yet, the thought of starting a weight training program can be daunting to many arthritis sufferers.

If you have arthritis and want to incorporate strength training into your health routine, these tips can help you get started.

An ad for an arthritis medication seems to suggest that taking it will alleviate or even eliminate morning stiffness, allowing you to hop out of bed. Like most drug ads, this one has unspoken messages and glosses over questions about side effects and cost.

Bring this article to your doctor appointment.

You've run out of options for hip pain and you're facing a possible hip replacement (see "Anatomy of a hip replacement"). Once your doctor has determined that you're a good candidate for surgery — based on your medical history, images of your hip, steps you've taken to reduce pain (such as weight loss and low-impact exercise programs), and how pain has affected your daily function — you'll need to ask lots of questions.

"This is not a time to be shy. Be aggressive and get answers. The doctor expects that," says Dr. Scott Martin, an associate professor of orthopedic surgery at Harvard Medical School and medical editor of the Harvard Medical School Guide Total Hip Replacement.

Gout, a debilitating form of arthritis, is on the rise compared with rates in prior decades. Obesity is probably a significant factor in this increase. Now, a new study suggests that three-quarters of gout cases in men might be completely avoidable by following certain protective health habits.

These painful flare-ups can occur suddenly and for no apparent reason. Here's what you can do about them.

Have you ever woken up with a mysterious egg-shaped swelling on your elbow or knee and have no clue what caused it? There is a good chance you have bursitis.

"Bursitis is definitely more common as you get older and just comes with the territory of living a longer and more active life," says Dr. Robert Shmerling, senior faculty editor at Harvard Health Publishing and Corresponding Member of the Faculty of Medicine at Harvard Medical School.

New guidelines suggest doing more of the same. The problem is that many people don't.

You never forget your first gout attack. The severe pain, swelling, and redness hits hard and fast. The initial attack often strikes your big toe's large joint, but later ones might affect the foot or ankle. Other hot spots include the knees, hands, and wrists.

First-line treatment is quite effective and includes anti-inflammatory medications, ice therapy, and rest. A combination of diet and lifestyle changes and prescription drugs — an approach called urate-lowering therapy, or ULT — is typically recommended if attacks recur or become more severe.