Maybe it started as a twinge in your shoulder when you reach above your head or an ache in your knee or hip after a hike, but once joint pain becomes consistent and gets in the way of your activities, you might wonder whether joint replacement is an option for you.
Joint pain and joint replacement
Joint pain has many potential causes. The most common is osteoarthritis, where the cartilage that cushions your bones wears down, causing the bones to rub against each other. This can cause pain, swelling and stiffness. Other causes of joint pain include injury, infection, bursitis and other types of arthritis.
In total joint replacement, a surgeon removes the damaged joint and replaces it with an artificial joint called a prosthesis, which can be made of metal, plastic or ceramic. The goal of the new joint is to allow a return to normal movement and activities. Joint surgery can treat some types of joint pain, but not others.
Joint replacements are among the most common orthopedic surgeries, with nearly 1.5 million being performed each year. Across our larger network, HCA Healthcare, there are approximately 70,000 joint (hip and knee) replacements per year. In the U.S., knee replacements outpace hip replacements, and shoulder surgery is less common, though numbers are on the upswing. People can have a joint replaced at any age, but the average patient is in their mid-60s.
While joint replacement surgery is safe, effective and increasingly common, it is still a major surgery and a big decision. Is it right for your situation? Here are some questions to consider.
When should you speak to your doctor about joint pain?
If you notice that joint pain is getting in the way of normal activities, it's time to talk to your doctor. If pain interrupts sleep, prevents regular exercise or makes it difficult to take care of yourself, you may be at higher risk of other health problems, such as diabetes or high blood pressure. Treating joint pain can help you return to healthy habits and regain quality of life.
What are the options for treating joint pain?
Before you start treatment of any kind, you should first see a physician to evaluate what's causing the pain. Your doctor will ask about when you notice the pain. Does it occur when you're walking, standing, getting up from a chair, or moving in and out of the car? Your doctor may order an X-ray or MRI to visualize the joint. Depending on the results, your doctor may recommend physical therapy, medication, injections to the joint, weight loss or a combination of treatments.
The goal of physical therapy for osteoarthritis is to strengthen the muscles around the joint, increase flexibility, and help you maintain or return to normal activities.
“If you are overweight, losing even a few pounds can reduce the load on your joints, reduce pain and relieve arthritis symptoms,” said Dr. Robin Goytia, an orthopedic surgeon at Texas Orthopedic Hospital. He also recommends activity modification, using an assistive device for walking, or wearing a compression brace or sleeve to hold the joint immobile so it can have time to heal.
Medication can also help reduce pain and inflammation. Injecting steroids or other substances into the knee can deliver fast relief for severe pain, but Dr. Goytia warns against the use of hyaluronic acid injections for knee osteoarthritis. These injections can be used to keep joints moving and reduce pain, but there isn’t enough evidence to prove that they actually work.
Even if you and your doctor eventually decide to proceed with surgery, these steps could shorten your recovery time or improve your outcome.
When is it time to consider surgery?
Everyone has their own tolerance level for joint pain caused by injuries or osteoarthritis. If you're an avid cyclist, hiker or soccer player and pain is keeping you from those activities, you may opt for surgery sooner than someone whose pastimes include reading or playing cards. If you've tried other treatments and you're still experiencing significant pain, it may be time to consider joint replacement.
How do you know if you are a good candidate for joint replacement?
Many factors can determine who is a good candidate for joint replacement. While there is no upper age limit for joint replacement, surgery carries risks that can increase if you have certain health conditions. These include heart disease, uncontrolled diabetes, obesity and high blood pressure. Your doctor will look at your whole health picture before they recommend surgery.
Does insurance cover the cost of joint replacement?
How much you have to pay will depend on the terms of your insurance policy. Some insurance companies, including Medicare, require documentation showing that other non-surgical treatments did not work before they will cover joint surgery. Check with your insurance carrier to find out exactly what they will cover and under what circumstances.
How much will joint replacement surgery relieve your pain?
“Most patients get significant relief and many wish they had done it sooner,” said Dr. Goytia. “Having said that, not all aches go away. Patients may continue to have some startup stiffness, residual swelling, and mildly diminished range of motion. Patients can continue to improve their function, endurance and strength until the one-year mark from surgery.”
What is recovery from joint replacement like?
Recovery is a very individual process and will depend on your physical health at the time of the surgery, which joint was replaced, and the type of procedure the surgeon used. While more and more joint surgeries are being performed without an overnight hospital stay, this is still a major surgery with a significant recovery period.
“On average, joint replacement recovery can take around four to six weeks, but everyone is different,” said Dr. Goytia.
In some cases, you can start using your new joint shortly after surgery, but you'll have to take things slowly. Your physical therapist will recommend exercises to help you get stronger and gradually build up to your regular activities. The more you know about what to expect from your specific procedure, the better prepared you will be for the recovery process.
Joint replacement is a big decision, but it might be the answer if significant joint pain is preventing you from living a healthy and enjoyable life.