Once considered high-tech, joint replacements are now a common operation. Surgeons replace more than a million hips and knees each year in the U.S. Studies show joint replacements can significantly relieve pain and increase mobility in about 90% of people who get them.
“Joint replacement can be a life-changing procedure for the right patients,” says Tariq Nayfeh, MD, PhD, assistant professor of orthopaedic surgery at Johns Hopkins Bayview Medical Center in Baltimore, MD, “but it won’t help everyone with hip or knee pain.”
If you’re suffering, how do you know if joint replacement is right for you? How can you weigh the potential benefits — less pain and a more active life — with the risks that always come with surgery? WebMD talked to some experts to find out when joint replacement makes sense — and when it may not.
Reasons for Hip or Knee Replacement
Who needs a hip or knee replacement? Surgeons look at a few basic criteria. They include:
Pain and stiffness. Most people who need joint replacement have severe pain that makes it difficult to walk, climb stairs, get up from a chair, or carry on with other normal activities. The pain is also chronic, lasting at least six months, says Matthew Austin, MD, an orthopaedic surgeon and spokesman for the American Academy of Orthopaedic Surgeons.
Poor quality of life. It’s not only pain itself that matters, but how the pain affects your daily life, Austin says. Do your joint problems limit what you can do? Do they affect your mood?
Bone damage. X-rays and other imaging may show severe joint damage from osteoarthritis or other conditions.
Treatment failure. Medication, injections, devices — like walkers — and other treatments aren’t helping enough.
Deformity. Your knee is severely swollen or your leg is bowed.
When Joint Replacement May Not Help
Joint replacement may not be a good idea if you have these problems.
Infection. “The number one reason to avoid a joint replacement is recent infection anywhere in the body,” says Nayfeh. That infection could spread to the area of the joint immediately after surgery or months later, causing serious problems — including joint problems and further surgery.
Other health problems. Anyone with a history of heart attacks or strokes or with currently uncontrolled diabetes may be at increased risk for complications. People who are very obese may need to lose weight before getting a joint replacement.
Uncertain cause of pain. Your surgeon must be certain that the pain you feel is really caused by joint damage and that replacing the joint will help.
“People can have pain that feels like joint pain, but the scans don’t seem to show damage in the joint,” says Nayfeh. There are lots of reasons for severe pain in the knee or hip — such as nerve damage — but a joint replacement won’t help with them.
Pain when at rest but not when walking. “Joint replacements are well established for treating pain that gets worse when walking,” says Nayfeh. “But people who only have pain while at rest seem less likely to benefit.”
Joint Replacement: Things to Consider
Even if you meet the requirements for joint replacement surgery, here are three key questions to ask yourself.
Could more conservative treatment work? Joint replacement is a common, effective, and relatively safe procedure. But it does have risks and full recovery takes months. Make sure that you’ve tried all of the nonsurgical treatments available first.
Do you have help at home? It may be difficult to recover from joint surgery alone. For at least a few weeks, you’ll likely need some assistance getting dressed, preparing food, changing your bandages, and moving around. If you don’t have family or close friends who can help, see if there’s a rehab facility where you could recover.
Are you committed to making changes? For a good result with joint replacement surgery, you need to commit yourself to hard work in the months before and the months after surgery. You may need to improve your lifestyle, eat healthier, lose weight, and exercise more.
“I tell people that when it comes to a successful joint implant, 10% of the success lies with the surgeon, 10% with the surgery, and 10% with the physical therapist,” Nayfeh tells WebMD. “The rest is up to the patient. If they don’t work at recovery, they don’t get better.”
If you don’t commit to making changes, the chances that you will have complications — or that your joint replacement will fail — are much higher. You need to be ready for joint replacement, mentally and physically.
Joint Replacement: Next Steps
Wondering what you should do next? Here are some suggestions.
Research joint replacement. There are many possible replacement joints and procedures. Read up on them. Check out reputable web sites, such as the American Academy of Orthopaedic Surgeons (AAOS) or the American Association of Hip and Knee Surgeons (AAHKS), says Austin.
Talk more with your doctor or surgeon. Learn the specifics about how the surgery would help and what recovery would be like. Ask how much experience your surgeon has with the specific surgery and replacement joint that he or she is recommending.
Get a second opinion. “I think anyone considering a joint replacement, or any major surgery, needs at least a second opinion,” says Nayfeh.
Consider the impact that surgery and recovery would have on your life. Think about how it would affect your job, if you work, or your home life. Talk to family members about whether they could help out during recovery.
Don’t rush yourself. When deciding whether to get joint replacement surgery, take your time. Make sure you have answers to all your questions before you make your decision.
Knee and hip replacements help reduce joint pain and increase mobility in many people. The impact on your life can be profound — restoring much of the freedom that daily pain took away.