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How Do You Know It's Time for Joint Replacement?

Judging when the benefits outweigh the risks is tricky. Here's expert advice on making the call.

By Winnie Yu

Even when your knee or hip is in chronic pain, it's not always easy to decide whether it's time to seek joint replacement surgery. Are you giving in too soon? Are you holding out too long? For those of us in middle age, it may seem too early to take the step, even to ease the pain of arthritis. But when your pain persists and worsens, and you've exhausted other options, postponing surgery might feel like torture.

(MORE: Your Guide to Avoiding Joint Pain)

The reason to opt for joint replacement is simple: You're sick of pain. The operation can relieve pain and swelling and help you regain mobility. But timing the surgery is rarely so clear-cut. "Pain is a sensation that affects each of us differently," says Dr. Robert Tait, an orthopedic surgeon in Henderson, Nev. "That is why the decision for joint replacement is always made by you and your surgeon together."

Gregory Martin, medical director of the Orthopedic Institute at JFK Medical Center in Boynton Beach, Fla., agrees. "I see some patients with severe signs of arthritis on X-ray, but somehow they are leading an excellent quality of life," he says. "Others may have early X-ray findings, yet are in terrible pain that they can't live with."

Every year, more than 1 million Americans replace a hip or knee, according to National Institutes of Health statistics. It's a procedure that has been increasingly embraced by those younger than 65. The number of Americans age 45 to 65 getting hip replacements tripled to 128,000 from 2000 to 2010, the latest year for which statistics are available.
Still, patients like Martha Richardson, a 55-year-old homemaker in Albany, N.Y., remain reluctant, even though her arthritis has made it difficult for her to do anything that involves a lot of walking. "I've heard horror stories" about surgical complications, says Richardson, who has had arthritis for more than five years. "So do I keep what I have and suffer or bite the bullet and risk something happening?"
The Waiting Game
"Toughing it out" isn't always as prudent as it seems when you factor in your quality of life. People who have joint replacement surgery, on average, experience severe hip or knee pain for seven to 11 years before going under the knife. Surveys indicate the delays are attributed to fear, limited awareness of treatment options and a lack of reliable information about surgical procedures.

Since chronic pain often leads to a sedentary lifestyle, Martin says, "Many people are so scared of surgery that they let their whole life slip away. They gain weight and stop doing activities they enjoy. They get stiff and then it affects their ability to walk."
Postponing surgery often means you're allowing pain to continue disrupting your quality of life. You may stop walking with your dog, playing golf or even enjoying sexual relations. (According to a recent, highly publicized study, more than 80 percent of people who have had a hip replacement say they enjoyed sex more after the surgery.)
(MORE: Replacing Old Joints Can Improve Your Love Life)

When the Time Is Right
Despite the benefits, rushing into surgery before carefully evaluating the pros and cons isn't advisable, either. Like any operation, joint replacement comes with potential hazards, like infection and blood clots. There can also be significant post-surgical pain, and even a limp. In a few cases, surgery needs to be redone if a replacement joint shifts or relocates. "Everyone is familiar with commercials that show a celebrity or sports figure doing amazing physical things after a joint replacement," Tait says. "However, results can't be guaranteed. This is a major, irreversible operation that carries with it risk that is rare, but can be quite severe and disabling."

Experts discourage patients from undergoing replacement if they haven't already tried non-surgical treatments, like exercise, weight loss, physical therapy, activity modifications, joint lubrication injections and anti-inflammatory medications.
For example, exercises to strengthen the muscles around a joint can often relieve the pain. "When the muscles are strong," Martin says, "they can support the joint better and take stress off when arthritis sets in."

Maintaining a healthy weight is especially important because it relieves the pressure that excess pounds put on the joints. "Many patients have been able to avoid joint replacement by achieving an ideal body weight," Tait says.


Above all, orthopedists advise, exhaust your nonsurgical options and be honest with yourself about what you've done to address lifestyle concerns before you request an operation.

So how do you know when it really is time? "The simple answer is, you'll know," Tait says. "That seems so unscientific. But this statement is as true today as it was 40 years ago when we began performing joint replacement."

(MORE: Prep Yourself for Surgery)

A good indication, he says, is when you start saying things like, "I can't take the pain anymore — I've got to do something" or "I can't live this way anymore."

For many people, early symptoms of osteoarthritis are mild and well tolerated, especially if they make lifestyle modifications. But when pain and stiffness start to affect your ability to work, sleep or do the things you enjoy, it's time to start contemplating surgery.
It's also important not to get hung up on your age. If your body is telling you that it needs the replacement, you should listen, whether you're 45 or 75. The key, Martin says, is being honest with yourself about how much you're really hurting and the toll it's taking on your life.

So consult your doctor, carefully consider the benefits and risks and get a second opinion. A good surgeon, Tait says, will take steps to confirm that your pain is coming from a joint and not being referred from a nearby area of the body, and that it's not an effect of nerve or vascular disease. (You can learn more from the American Academy of Orthopaedic Surgeons.)

Winnie Yu is a freelance journalist who has contributed to magazines including Woman's Day, Health, Prevention and Scientific American Mind.  She is also author of several health books on topics including arthritis, Alzheimer's disease and diabetes. Read More
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