It’s estimated that 54 million adults in the United States are living with arthritis, a group of diseases that affect the joints, causing symptoms like joint pain, swelling and stiffness.
The most common type of arthritis is osteoarthritis, a degenerative condition in which the cartilage between your joints breaks down. For some, the condition is manageable with so-called conservative treatments. These may include lifestyle modifications—such as exercising regularly and maintaining a healthy weight—as well as medications and physical therapy. For others, symptoms may worsen over time and affect your ability to perform daily activities.
If conservative treatments have proven unhelpful and you continue to experience pain, stiffness and disability, your doctor may recommend joint replacement surgery—especially if your knees or hips are affected, as they’re the most common type of joint replacement.
Who typically receives joint replacement surgery?
While more than 95 percent of total knee replacements are done for people who have osteoarthritis, the procedures may benefit people with other conditions, as well. Those who experience post-traumatic arthritis—such as from a sports-related or accident-related injury to the knee—or knee damage resulting from an infection, a bone tumor or a change in blood supply that results in bone damage may also be candidates for knee replacement surgery.
Although osteoarthritis is also a common reason for hip replacement surgery, people who have any condition that deteriorates the ball-and-socket structure of the hip—such as developmental abnormalities, childhood hip disorders, trauma, tumors or tissue death—may also consider hip replacement surgery as an option to repair the joint.
Those who have inflammatory types of arthritis, like rheumatoid arthritis, gout or psoriatic arthritis may also consider knee or hip replacement surgery.
Deciding whether or not to go through with joint replacement surgery is a big decision, of course, so it’s important to weigh the risks and benefits. Here’s what you should know.
Signs to look out for
There are a few telltale signs that it may be time to consider hip or knee replacement surgery.
“The number one sign is pain, usually that’s what brings people in,” says Eric Schiffman, MD, an orthopedic surgeon at Aventura Hospital and Medical Center in Aventura, Florida. “But the second thing is loss of function.”
According to the American Academy of Orthopaedic Surgeons, you may be a good candidate for hip or knee replacement surgery if:
- You’re unable to perform daily activities due to pain
- You experience pain or stiffness even when lying down or at rest
- You’re in pain despite taking medications or receiving injections
- You find that supportive devices, like walkers and canes, do not provide relief
- You did not experience improvement with physical therapy
- You have significant inflammation, swelling or joint deformity
Another sign it may be time for a joint replacement: You’re finding workarounds for how to accomplish certain tasks.
“Some people in need of hip replacements find they can no longer get their socks and shoes on, because they’ve lost that motion,” says Dr. Schiffman. This may result in needing help to get them on or wearing only slip-on shoes or options without laces, he explains.
Are you a candidate for surgery?
Recommendations for surgery are individualized, based on your personal level of pain and disability and an assessment from your doctor.
“For my patients, I always try to make sure that conservative measures have not helped them,” says Schiffman. According to the Arthritis Foundation, people who have osteoarthritis may first try a number of non-surgical methods to reduce pain and improve mobility, including:
- Getting regular physical activity
- Strengthening muscles to help support the joint
- Stretching the joints to reduce stiffness and pain
- Maintaining a healthy weight
- Balancing activity and rest
- Avoiding excessive, repetitive movements
- Using hot and cold therapy
- Employing assistive devices—including mobility aids like canes and walkers, bathing and toileting aids like grab bars and shower benches and devices you wear on your body, such as orthotics and braces
- Taking over-the counter or prescription medications for pain
- Managing pain with injections
- Doing physical or occupational therapy
- Trying cognitive behavioral therapy (a form of talk therapy), to help cope with the psychological effects of chronic pain
It’s important to remember that, as a degenerative condition, osteoarthritis worsens over time. That means that while medications can help reduce symptoms like joint pain and inflammation, they don’t do anything to fix the condition itself. In other words, says Schiffman, there’s no cure.
“I give the analogy of a car tire,” says Schiffman. “You can have a bad car tire, and you can drive with a bad car tire for as long as you can drive relatively well. But when that driving gets bad, it’s time for a new tire.”
Considering joint replacement surgery: next steps
Schiffman advises his patients that if they can manage their pain, they may be able to keep living with their condition. But when non-invasive ways to manage symptoms are no longer working and your quality of life is adversely impacted, it may be time to consider a knee or hip replacement.
“My mantra to my patients is this: ‘I never tell you that you need a hip or knee replacement. You tell me,’” says Schiffman.
Your decision-making process should begin with conversations with your family and your primary care doctor. Then, once you’re ready to explore your surgical options, your doctor should refer you to an orthopedic surgeon, the type of specialist who performs the procedure, who can give you more information about what the procedure entails as well as the potential risks and benefits.
Choosing your surgeon
It’s essential to be as selective as you can when it comes to finding a good surgeon.
You want one who does these procedures often because the more a surgeon does, the more adept he or she is, says Schiffman.
Some research suggests that it’s ideal to seek a surgeon who performs at least 60 knee replacement surgeries per year. For hip replacements, that number would be at least one per month.
It’s equally important to look at how many hip or knee replacement surgeries the hospital itself does. “The more hip and knee replacements a hospital does, the better chances of having a complication-free surgery,” Schiffman says.
As successful as hip and knee replacement surgeries are, it’s still a big procedure, so it’s important to think through your decision. “Some joint replacement surgeries are done the same day, so it may seem similar to going in and getting a skin tag removed,” says Schiffman. “But it’s not. It’s really a big deal.”
Schiffman advises that you do you due diligence: “Strongly consider whether or not you should have surgery and really do research on the doctor and on the hospital. Give your decision the weight that it deserves.”
Managing expectations
It’s also important to have realistic expectations of what your surgery will accomplish.
On the plus side, most patients with knee or hip replacement surgery do experience reduced pain and improved function and quality of life. But neither knee nor hip replacements are fool-proof.
Like your own joints, the artificial joints you’ll receive are subject to wear and tear. And although most patients are able to get back to their normal daily activities, you’ll probably be limited in your ability to do more intense forms of exercise. In other words, you’ll likely have to forgo running, jogging or jumping with your new joint in favor of lower-impact activities like walking, swimming and biking.
