The decision to proceed with a total joint replacement is rarely easy.
A patient with osteoarthritis usually experiences a gradual increase in pain and functional disability, which means the patient will have fewer and fewer good days and pain will frequently affect sleep. Normal daily activities such as shopping and climbing stairs become exceedingly difficult. Medication, injections, and other treatments lose their effectiveness, and depression can easily set in as a result of the difficulties the arthritis causes.
The description above sounds rather doom and gloom, but keep in mind we’re talking about one of your joints not functioning like it’s supposed to. After a patient has exhausted all other options and quality of life has degraded, it’s time to talk with a primary care physician.
Your physician will observe objective changes.
- The affected joint will be persistently swollen.
- You will have the ability to feel the noise produced by the roughened joint surfaces.
- X-rays will show loss of cartilage thickness, spurs, and bone cysts. This alone is not enough to warrant joint replacement. I have seen x-rays where there is a tremendous amount of damage, but the patient had little pain and could even do physical labor. This works the other way as well where there is little damage but a great deal of pain.
Objective change is not enough because–as implied above–tests do not dictate a patient’s quality of life. That’s why I treat patients not tests.
If all other treatment options are exhausted, then it is time to consider surgery. One must also weigh the contraindications (specific situations in which a drug, procedure, or surgery should not be used because it may be harmful to the patient) to surgery.
- Has the patient had a previous infection in the affected joint?
- Does the patient have a heart condition that makes surgery too risky?
- Can the patient tolerate the required anesthesia?
While your physician can consider the conditions, indications, and contraindications and recommend surgery, patients must ultimately make the decision based on pain and disability. Are you living the life you want to be living, or is pain/arthritis holding you back?
Joint replacement surgery is a highly successful procedure. So much so that it is rare for a patient to say he/she is sorry to have had it done.
If you’re experiencing these symptoms, then you need to decide how you want to proceed. What is best for you?
Remember. The basic goal of a joint replacement is to relieve pain and restore function. By accomplishing these goals, your quality of life improves. Many people who seek joint replacement procedures desire only to accomplish simple goals: getting out of a chair easily, walk without pain or a leg giving out, and go up and down stairs.
Others pursue more aggressive goals like returning to tennis, skiing, or biking. Make sure to discuss your personal goals with your physician before making a decision about joint replacement.