When deciding on a joint replacement, consider reflecting on the severity of your pain, how your pain is affecting your social life and relationships, and your level of understanding of the surgery and necessary recovery. Oftentimes surgery can be done prematurely as people commonly think it is the only option for arthritis pain relief. Research now points to other effective treatments for arthritis relief including lifestyle modifications such as weight loss, exercise, and physical therapy. Joint replacement surgery is a big decision and in order to have confidence in your decision it is important to consider a few things first.
I once heard, “the only surgery that doesn’t come with a risk is the one that you don’t have”. It’s true, there isn’t one surgery that doesn’t come with at least some degree of risk. This is why it is very important to weigh the risk vs reward, especially for a major surgery like a joint replacement.
There isn’t a cookie cutter way of looking at if you need a joint replacement but there are some things to consider.
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First, let's look at some numbers...
Let’s look at eligibility for joint replacements. They may not be as necessary as you think. One study completed in Spain was looking at the prevalence of knee and hip arthritis in a group of people and how many were eligible for a joint replacement surgery.
In close to 8000 patients they found that,
- 7.4% had hip osteoarthritis
- Out of the approximate 592 patients, 37% of men and 52% of women were appropriate for total joint replacement surgery
- 12.2% had knee arthritis
- Out of the approximate 976 patients, 11.8% of men and 18% of women were appropriate for total joint replacement surgery (Quintana et al, 2008)
So what do these numbers tell us?
Joint replacement surgery is not your only option when it comes to arthritis. There are many people who can manage their pain successfully without it. The goal of this study was to prove to you that joint replacement surgery may not be as necessary as we once thought.
Another study looked at classifying knee replacement surgeries from previous studies into different categories, one being “premature” or potentially inappropriate. It was found that if you were of younger age (no specific ranges given) and living alone, those were two characteristics that could increase risk of premature knee replacements.
The way osteoarthritis is viewed in society can be one of the reasons surgeries are done prematurely. For example, when deciding on a joint replacement, the same study found that:
“The anticipation of disability associated with knee osteoarthritis may be driving patients who live alone to seek surgery when the disease is in its early stages in order to avoid the functional limitations associated with progression of the disease.”
(Ghomrawi et al. 2020)
You have options other than joint replacement surgery
If you are feeling hopeless in your arthritis condition, there are some resources that can help guide you to hope! Here is a video on how to find hope.
I often find that when people are deciding on a joint replacement, they feel they are backed into a corner with surgery as their only option for relief. With a quick doctor’s visit and doom and gloom of articles online, it may appear that way.
What many people miss is that there are other options. Learning about the other options as well as taking into consideration what is involved in a joint replacement surgery is important to make the best decision for yourself.
Surgery may seem like the only way out at the moment, with the dialogue of “if my joint hurts, getting a new joint seems like the best solution for pain relief”.
Unfortunately, I know quite a few people who received surgery but had no idea what to expect afterwards. They were taken aback by the pain levels and lengthy recovery.
My ultimate goal of this article is to help you make the best decision for yourself.
As a precursor, I’m not here to demonize surgery. Joint replacements can absolutely be successful if you are appropriate for one. Conservative treatment does not work for everyone. But I do know some who felt they had no other way out and opted for surgery without proper preparation or knowledge of recovery– this can negatively impact the success of the joint.
Surgery is necessary in some situations but what I want you to know that it is not inevitable for all osteoarthritis. When deciding on a joint replacement, it is important to consider all factors.
Going through these following questions can give you some clarity on your decision. Instead of feeling overwhelmed, we want you to feel confidence in this decision. Consider the following:
FIVE questions to ask yourself before deciding on a joint replacement
Based on the research and clinical experience as a physical therapist, I have gathered a few primary questions to ask yourself when trying to make a decision.
There aren’t exactly specific criteria that if you meet all of them you are a candidate for surgery which can make for some grey area when deciding.
It’s ultimately what is best for you but here are some questions to help you figure that out.
1. How severe is your pain?
Pain can be one of the main determinants when deciding on a joint replacement. Reflecting on your pain levels and what it is actually limiting your from can help effect your decision. Many studies have examined what aspects of pain we should be looking at when deciding if a joint replacement is appropriate for us. Let’s look at this one in particular.
This study used the following criteria below to prioritize joint replacement surgery for patients. Here are some of the questions they looked at.
How would you rate the severity of your pain or difficulty in these situations?
Pain in motion:
- None/mild: Pain or discomfort described by the patient as slight during routine activity. Patient has not altered patterns of activity or stopped activities because of pain.
- Moderate: Pain or discomfort described by the patient as moderate during routine activity. This level of pain results in modification or abandonment of some activities.
- Severe: Pain or discomfort described by the patient as severe during routine activity that results in serious limitations.
- None/mild: Able to walk 1 hour on an even surface.
- Moderate: Able to walk 500 meters half an hour on an even surface.
- Severe: Able to walk less than 500 m or 15 minutes on an even surface.
Pain at rest (sitting or in bed)
- None/mild: Discomfort described by the patient as slight that does not or only occasionally interferes with sleep.
- Moderate: Pain described by the patient as moderate that regularly interferes with sleep.
- Severe: Pain described by the patient as severe that prevents sleep (Escobar et al, 2007)
Rate each one of these areas. This will be one of the pieces of the puzzle for your decision for a total joint replacement surgery.
If you were answering in the mild to moderate categories, surgery may not be your very next step. If you were in the severe categories, it might be time to consider. Let’s look at some more questions.
I do also want you to know that there are things you can do to manage pain as well, no matter which category you are in. This is even including if you have bone on bone arthritis (read more about that in this article).
2. How does your pain affect your social life?
The next step is to think about your social life and responsibilities. This might not be intuitive when deciding on a joint replacement but it is very important.
- Do you live alone?
- Do your family members or loved ones rely on you for care?
- Do you have a demanding job that you are unable to do or have severe difficulty completing the tasks you need to?
- Do you have pets that you need to care for?
- Are you unable to enjoy memories with your grandchildren because of pain?
- Have you had to say no to certain family gatherings or travel plans because of pain?
These are important considerations as the recovery process can be lengthy and you will need support from friends, family, neighbors or someone you can count on.
If you have people that are counting on you in your home, at work, or somewhere else, it may lead to high stress levels that may negatively impact your recovery. You need to be able to focus time and energy on your recovery.
It is possible to make arrangements post-op whether it is someone that could come offer assistance, someone you could stay with temporarily, or a paid aide service that could help out. There are options if you decide on surgery.
Also, consider how much you may have missed out on because of your pain and what you are looking forward to in your future. This can definitely weigh into the decision.
3. Do you understand what the joint replacement recovery entails?
Joint replacements can have a rather lengthy recovery, which is common for most major surgeries.
Although, I commonly find people are unaware of how extensive the recovery process can be.
For each type of joint replacement surgery, you do have to be diligent with movement and understand the rehabilitation requirements to get the most out of your procedure. If you don’t put in the work, you may not see the results you were searching for.
Check out the different joint surgeries below and common recovery timelines before deciding on a joint replacement.
- Knee replacements tend to have a recovery time of about 6-12 months depending on how strict you are with following the recovery guidelines and your rehabilitation. It includes daily physical therapy and exercises, movement at least every hour or two, and following other surgical recommendations such as wearing TED hose and regular icing. You may be in physical therapy for up to 6 weeks depending on your recovery. All of these contribute to optimal results of regaining range of motion and strength. If you don’t regain your knee range of motion, there can be complications.
- Hip replacements do tend to require less physical therapy and a less regimented exercise program. Depending on who does the surgery and how conservative they are, you may have hip precautions up to 6-8 weeks post op. These usually include limited bending, avoiding crossing your legs, and avoiding extending your leg too much. It is usually pretty easy to adhere to these precautions though. Here is more info on what to expect.
- Shoulder replacements typically have a much longer recovery time. Some say up to even a year to achieve a full recovery. Depending on the surgeon, you may have limited use of your arm up to 10-12 weeks. Physical therapy is usually necessary to regain your range of motion and strength. You may have a longer course of physical therapy (6-12 weeks on average) as the shoulder joint tends to be a little more complicated than knees and hips.
4. If you get a joint replacement, do you have a plan to stay moving?
Chronic pain and stiffness may have led you to move less than you have in the past. With inactivity comes increased risk for other chronic diseases like high blood pressure, obesity, diabetes, etc.
New found mobility from a joint replacement can make it easier to move and therefore further prevent chronic diseases. So then, it’s time to take advantage!
Not only will movement help prevent chronic disease but also helps to improve surgical outcomes. Following the surgery, if you aren’t moving as much as is prescribed- the results of the surgery may not be optimal and you may find yourself back to square one with pain.
Before deciding on a joint replacement, it may be helpful to think about which activity you would like to get back to. You can also think about an activity you would like to try if pain wasn’t stopping you!
This can help to motivate you along the recovery process.
It is so important to have a plan to get strong and stay active.
5. Have you tried conservative treatment?
Research shows exercise and diet changes can be as effective as surgery in most cases. This includes quality physical therapy, modifying your eating habits, weight loss, focusing on quality sleep, reducing stress, and increasing activity levels. Here is a list of 15 ways to help manage inflammation you can try.
If you have truly exhausted all of these options then surgery might be the right choice.
Surprisingly, some things that can make a big impact to osteoarthritis pain is protein intake, exercise to build cartilage strength, and lack of sleep often get overlooked. I promise you, weight loss is not the only way to find relief.
It is very important to understand that there is a level of risk with surgery and can require lots of work to ensure optimal recovery. Unfortunately, the absence of pain is not guaranteed. It is important that you give other conservative efforts a try because you may be surprised!
Deciding on a joint replacement surgery decision tree
In summary, this decision tree below can help you weigh your decision on whether to consider a joint replacement surgery.
Please note this is NOT a black and white decision. This decision tree is simply to assist you in making an informed decision.
When deciding on a joint replacement there are lots of factors to take into account. This chart is simply a summary to help you to prioritize the factors that influence the decision.
How to prepare for recovery
Once deciding on a joint replacement, it is important to be as prepared as possible to optimize your recovery.
After experience in seeing patients in home care following total knee and hip replacements, I’ve realized just how important having the right equipment in your home can be.
Equipment you should consider having in your home after surgery:
You will also likely need support for cooking and cleaning for the first few weeks so you don’t overdo it.
Supervision is always a good idea for the first week or so to monitor for adverse reactions and keep track of medications.
You will need to make sure physical therapy is set up and you are consistent with your exercises regarding range of motion and strength, these are likely done up to 3-5 times per day.
As you can see you need to ask questions and make sure you have all the information when it comes to deciding on a joint replacement.
Surgery is not a cookie cutter decision
Each situation is different. I always tell people, if it is truly impacting your quality of life and you have tried other conservative treatments without success, surgery may be a viable option. There is no sense in suffering, especially when other options are not successful.
When deciding on a joint replacement, it is important to understand that it is not considered a “failure”. Conservative management does not work for everyone and that’s okay!
I have met so many people over the years who have had success with joint replacements. I have also met some that have not which is why it is a big decision. Weighing pros and cons and being educated on the process is extremely important.
If your life continues to be negatively impacted by your arthritis pain, surgery may be appropriate. Some instances include: decreasing time spent with family and friends due to pain, increasing depression or other negative emotions, living on your own with very limited help, needing to improve pain in order to take care of a loved one, etc.
This decision can be a complicated one. Consider each of your answers to the questions above before deciding on a joint replacement surgery to ensure optimal results and confidence in your decision!
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Disclaimer: This post is for general informational purposes only. It should not be used to self-diagnose and it is not a substitute for a medical exam, cure, treatment, diagnosis, and prescription or recommendation. It does not create a doctor-patient relationship between Dr. Kuhn and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Move Well Age Well, LLC and Dr. Alyssa Kuhn, PT, DPT are not liable or responsible for any advice, course of treatment, diagnosis or any conclusions drawn, services or product you obtain through this post, video or site.