Joint Replacement Archive

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Q. I have osteoarthritis. My right knee is especially painful and stiff. How do I know when the time is right for knee replacement surgery?

A. Timing is key. If you get the procedure too soon, you might not see enough improvement to make the surgery worth it. In addition, the younger you are when you have knee replacement surgery, the greater the chances it will not last and another surgery may be needed. But if you wait too long, you may subject yourself to unnecessary pain and disability.

You've tried nearly everything for your worn-out knee. But the remaining possibilities may include some risky options.

Knee osteoarthritis affects about half of us in older age. The cartilage that acts as a cushion between the bones wears away, and it hurts when the bones grind against each other. In many people, arthritis can become severe enough that they consider a knee replacement. Since surgery is an expensive and complicated option, you may wonder what else you can do to reduce knee pain. Beware: some treatments are bogus and even dangerous.

Stay away from these

The first sign that a knee pain treatment isn't the best choice: an ad promising that it's the surefire solution.

If you suffer from joint pain, exercise may seem like the last thing you want to do, or need to do. But the right exercises performed properly can be a long-lasting way to subdue ankle, knee, hip, or shoulder pain. For some people, the right exercise routine can even help delay or sidestep surgery.

While exercise is great medicine, it only works if you carve out time to do it regularly. And sometimes the hardest part of a workout is getting started. Here are four ways to help you get your dose of physical activity:

Thinking about a total knee replacement? There are a few different kinds of knee implants that are used in this procedure. The different types are categorized by the materials that rub against each other when you flex your knee:

Metal on plastic. This is the most common type of implant. It features a metal femoral component that rides on a polyethylene plastic spacer attached to the tibial component. The metals commonly used include cobalt-chromium, titanium, zirconium, and nickel. Metal-on-plastic is the least expensive type of implant and has the longest track record for safety and implant life span. However, one problem that can happen with plastic implants is an immune reaction triggered by tiny particles that wear away from the spacer. This can cause bone to break down, leading to loosening and failure of the implant. Advances in manufacturing have greatly reduced the rate of wear in the plastic.

In the journals

A study published online March 14, 2017, by The Journal of the American Medical Association suggests that when it comes to speed of recovery after a total knee replacement, a home-based rehabilitation program is as good as rehab that starts with a stay in the hospital.

Researchers randomly assigned people with osteoarthritis undergoing total knee replacement into two groups for 10 weeks of therapy. Those in one group received 10 days of hospital inpatient rehabilitation followed by a clinician-monitored program that they attended two to three times a week for eight weeks. Those in the other group skipped the hospital rehab and went straight into the clinician-monitored program but then progressed to at-home exercises.

News briefs

 Image: © Wavebreakmedia/Thinkstock

Many older adults have pain from knee osteoarthritis, a condition in which cartilage in the joints wears away. But when is it time for joint replacement? An observational study published March 28, 2017, in The BMJ suggests that a new knee improves quality of life only in certain cases. The study included over 7,400 middle-age and older adults who already had knee arthritis or were at high risk for the condition. Compared with people who didn't have knee replacement, those who had the surgery during the 26-year study period appeared to have a better quality of life afterward. However, the improvements were minimal, except in people who were less physically functional before the surgery because of more severe arthritis symptoms. The authors suggest that the high costs of knee replacement may be justified only in those who are severely affected by arthritis. What if your symptoms aren't severe? As we reported last month, it may be possible to delay or avoid knee surgery by strengthening your leg and core muscles, losing weight, and improving range of motion.

If you're having the occasional twinge of joint pain when you go for a walk or climb stairs, or you're worried about arthritis because a parent had it, one step toward prevention is to check your weight.

There are two ways that being overweight raises your risk for developing osteoarthritis (the most common joint disorder, which is due to wear and tear on a joint). First, excess weight puts additional stress on weight-bearing joints (the knee, for example). Second, inflammatory factors associated with weight gain might contribute to trouble in other joints (for example, the hands).

A desire to stay active and a natural aversion to pain send nearly 800,000 Americans to orthopedic surgeons each year for a hip or knee replacement. And we're seeking these operations much earlier in life. According to Dr. Scott Martin, associate professor of orthopedic surgery at Harvard Medical School, this isn't a healthy trend. "A lot of joint replacements are being done because they can be," says Dr. Martin.

Every surgical procedure carries the risk of complications — or even death. Because the average joint that's replaced only lasts 10 to 15 years, having the procedure done at age 50 instead of 70 means there's a good chance you'll need a second procedure when you're older and at higher risk for complications.