When should you replace that aching joint?
October 23, 2018
If you are suffering from chronic joint pain, you may be thinking about whether it is time to consider joint replacement. On the spectrum of treatments, you will find a range of options that may or may not include joint replacement, but which all focus on pain relief and restoration of mobility.
“We want people to be pain-free and full function,” says Gregory Komenda, MD, a board-certified orthopedic surgeon who practices at the Swedish Orthopedic Institute and other clinics. “The first options to consider are all of the conservative options, which include physical therapy and bracing and modifying activities, and there are medications that we can inject into the joints — the knee in particular. We can treat with cortisone, and there are also the lubricants we call viscosupplements. Ultimately, if someone has not improved enough where they don’t have their quality of life, we can look at partial and full knee replacement, or shoulder replacement, or hip replacement.”
The best option depends, on a large measure, on the patient. Does the patient want mostly to stop the pain? Does the patient want to avoid surgery as long as possible? What sorts of activities does the patient want to do?
While each patient is different, Dr. Komenda says, “People are much more aware of the options that are out there. People’s expectations are that they don’t want to feel pain, they don’t want to have limitations, and they want to continue to have a highly active life.”
Helping a patient decide
“The key thing is to really sit down and talk with the patient,” says Dr. Komenda. “That means taking a thorough history, performing a thorough exam, and perhaps conducting imaging studies.”
The information helps determine what’s causing the pain and limited motion. Is it a rotator cuff tear or arthritis?
“The number one consideration is making a good, accurate diagnosis and then sharing that with the patient and then explaining options,” Dr. Komenda says. “I always tell people that with anything in life, they always they have three choices. Number one is ‘do nothing.’ In orthopedics, number three is ‘fix it.’ Number two is ‘all the options in between.”
Even then, two people might have different attitudes about the same kind of joint problem. One might want to avoid surgery. One might want the problem fixed yesterday.
“As a doctor, we’re a team with the patient,” he says. “Doctors should never be pushing a decision on a patient.”
Surgical techniques and recovery time
How long does it take to recover from joint replacement?
“I would say the vast majority of patients are going home the next day,” Dr. Komenda says, with follow-up appointments at 10 days, six weeks, three months and one year. In many cases, patients can put weight on their joints when they wake up from surgery. Hips and shoulders tend to recover more quickly than knees.
Many joint replacement surgeries are performed robotically, which allows the surgeon to target the joint extremely accurately. Such surgeries make placements of joints more accurate and, it is hoped, deliver better outcomes, Dr. Komenda says.
MAKOplasty: Robotic-Assisted Surgery for Partial Knee Replacement:
Learning more about your options
To discuss joint pain solutions with a Swedish health care provider, find one near you in our online directory. Sign up for a free and informative Swedish orthopedic seminar for answers to your joint replacement questions.
“Do I Need a Joint Replacement?” asks the American Association of Hip and Knee Surgeons.
The Arthritis Foundation invites you to explore joint pain issues by asking “Where Does It Hurt?” You can browse issues relating to pain in your ankles, knees, shoulders, hips, back, neck, elbow and wrists.
The University of Massachusetts Medical School conducted a study that suggests patients who wait too long to have joint replacement surgery may not benefit as much as those who act more quickly.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.