When is the right time to have a joint replacement?

When is the right time to have a joint replacement?

I have received comments from the Blog and patients regarding the timing of joint replacement surgery. One of the most frequently asked questions is “How will I know when is it time to proceed with surgery?”. A combination of factors influence a patient’s decision to have joint replacement. These include pain, loss of motion, loss of function, and x-ray changes demonstrating significant arthritis. The outcome of joint replacement surgery is influenced by age, surgical technique, history of prior surgery, implant design, and diagnosis. Most people elect to try conservative or non-operative measures prior to proceeding with surgery. Once these have failed and the patient’s pain and decreased function is significant, they will elect to proceed with surgery.

In the younger individual, you must consider the fact that there are no “life-time joint replacements?” and most likely, subsequent surgery will be needed down the road. It is important that you discuss with your orthoptic surgeon the pros and cons of joint replacement surgery, the expected longevity, and what to expect if and when the implant wears out. A balance between discomfort and loss of function in the present versus the need for subsequent surgery in the future can be struck effectively by understanding the procedure, the realistic expectations, and the potential functional limitations that result from surgical treatment of an arthritic joint.   

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  1. Victor Rader

    I’m 52, and have scheuled my 3rd knee scope on my left knee for my latest cartlidge tear a few weeks ago.

    Prior to that, from excruciating deep seated pain in the left knee from one hike at the beginning of spring, and on bike rides during the summer, I was considering a total knee replacement, but I was advised to take Celebrex on a regular basis 1st. This does help to block out the pain, so I’ve been using that when necessary, then, as mentioned above, I had this tear while just painting my deck railing and twisting from an awkward position.

    I understand the argument to post-pone as long as possible, but is would be nice to see some data on how long these are lasting, 15, 20 or 25 ??? If it’s really only 15, I should probably wait, but if it’s 20 , I’d make it into my 70’s. My right knee is also pretty bad, and will probably need the same thing eventually, and if I had the left done now, it would stagger in time with the right.

    If you have, or can point me to any data on how long these are lasting I would appreciate it.

  2. Dr. William Barrett

    Dear Victor,
    The data of knee replacement in 50-year-old individuals would indicate there is a 90% probability your knee replacement would last 10 years. The data on knee replacement beyond 10 years in 50-year-olds is not as reassuring. An older study indicates that the success rate in patients in their early 50’s drops off to the 80’s at 15 year follow-up. If you have reasonable cartilage it would be best to continue with the arthroscopic treatment and the nonoperative care until you get to the point where your joint surface is worn down bon-to-bone. If and when that time is reached then knee replacement surgery would be advisable for treatment of the pain and loss of function. You should discuss the pro’s and con’s of different timing options with your surgeon.
    Regards, William Barrett