Decision making for joint replacement

Decision making for joint replacement

Patients present with a variety of symptoms and severity of arthritis of the hip and knee. The goal of management of an arthritic hip and knee is to maintain your own joint as long as it is able to provide reasonable function without significant pain. Therefore, initial treatment for mild to moderate arthritis always involves things you can do as a patient, such as weight reduction, low impact exercise and strengthening to improve not only your overall health, but the muscles around the affected joint. Use of over-the-counter anti-inflammatory medications such as ibuprofen or Naprosyn can be useful as well as pain relievers such as Tylenol. As arthritic involvement of the hip or knee becomes more moderate to severe, prescription anti-inflammatory medications can be utilized and shots of either cortisone or lubricant type materials such as Synvisc can be considered. Once arthritis becomes more severe, consideration of surgery to treat the arthritic joint can be discussed. The indications for some form of joint replacement include increasing pain, decreasing function and the negative affects of these on your quality of life. If you have failed nonoperative treatment measures and x-rays reveal significant loss of joint space consistent with progressive osteoarthritis, then discussion with an orthopedic surgeon over the options for treatment is appropriate. This process should be a shared decision-making relationship where you as a patient gather as much information as you can from your interaction with your doctors, as well as what is available in a variety of Internet websites. In this way you can educate yourself about the options available and have a discussion with your surgeon about which particular option make sense for you.

With regard to arthritic knees, there is the option in younger individuals for an osteotomy to shift the weight from the more involved side to a less involved side of the knee. Once the joint has lost all of its cartilage, some form of replacement is typically preferred. This includes a partial knee replacement which is utilized in roughly 10% of patients, or more commonly a complete knee replacement that resurfaces all 3 parts of the knee. The preoperative evaluation, the hospital course, and the recovery will be discussed prior to surgery. You should make sure you have all of your questions answered and understand the procedure, the expected outcome, and risks.

With regard to hip replacement, once the joint space has been lost and severe arthritis is noted, then total hip replacement is the procedure of choice. In 2012 the most common bearing surface for hip replacement is a polyethylene liner, with either a metal or ceramic ball. The majority of cases done in the United States at this time involve a cobalt chrome metal ball against a highly crosslink polyethylene liner. The socket that contacts the pelvis is typically made out of titanium and a titanium stem of a variety of designs is typically used inside the thigh bone.

In most cases, patients are in the hospital 1 to 3 days depending on the type of procedure they have. They typically can put all of their weight on the affected limb with the use of ambulatory aids such as a walker or crutches to begin with, progressing to a cane as they feel comfortable.

If you have arthritis involving your hip or knee, the first steps are to do as much as you can to improve your health and function and mitigate the discomfort from the arthritic joint. If your arthritis progresses, educate yourself as much as possible about the treatment options and have a discussion with your physician so that together you can make a shared decision about what is best for you moving forward in the treatment of your arthritic joint.

—William P. Barrett, MD