When is it Time to Have a Joint Replacement?

Tuesday, November 16, 2004

Your joints are involved in almost every activity you do, from walking and bending to turning the pages of a book. Normal joints move easily and without pain. But a diseased or injured joint—and the resulting pain—can greatly limit a person’s mobility and enjoyment of life.

A joint is formed by the ends of two or more bones that are connected by thick tissues. The knee joint, for example, is formed by the lower leg bone and the thighbone. The hip joint is a “ball and socket” structure. The bone ends of a joint are covered with a smooth layer called cartilage.

Causes of Joint Pain
A joint may become painful for many reasons. Arthritis (inflammation of the joints) is the most common cause of joint pain. Other causes include damaged or diseased cartilage, genetic disorders such as bowleg or knock knee, or extreme “pounding” of the joints during sports or other activities. Many obese people have joint problems because their weight places extra stress on their hip and knee joints. And some people simply are more prone to joint deterioration.

Some people with joint pain can take medication and live with their pain. But a physician should monitor the person’s joints and mobility for possible future problems. If the pain is bad enough, a person will avoid using the joint. This in turn can weaken the muscles around the joint, making it even more difficult to move.

Joint Replacement
To replace a joint, an orthopaedic surgeon will remove the diseased or damaged joint and replace it with an artificial joint (or prosthesis). The artificial joint may be composed of a combination of metal, plastic, and ceramic materials. The joint replacement is designed to move just like your normal joint with a goal of relieving pain and restoring mobility.

Depending on the damage to a joint, all (total joint) or part (partial joint) of the joint can be replaced. In an arthritic hip, for example, it may only be necessary to replace the ball part of the joint while leaving the socket intact.

Hips, knees, and shoulders—the largest joint systems in the body—are the most common joints that require replacement. Because these joints tend to get the most use, they’re more susceptible to injury and disease, and also wear down with age. Other joints, such as elbows, ankles, wrists, and small joints in the hand also can be replaced.

When Should You Consider a Joint Replacement?
It may be time to consider a joint replacement when:

  • Your level of pain and mobility restrict your work, recreation, and the ordinary activities of daily life.
  • Your pain has become incapacitating.
  • Pain is not relieved by more other methods of treatment, such as medications or physical therapy, the use of a cane, and/or by limiting your activities.

Start with a visit to your physician for an examination, tests, and x-rays to show the extent of damage to the joint. Your doctor may prescribe medication, therapy, or other treatments. If various treatment options don’t offer sufficient relief, your doctor may recommend joint replacement surgery and refer you to an orthopaedic surgeon for evaluation. Because joint replacement is major surgery, it’s important to discuss the risks and benefits of the surgery with the surgeon.

The vast majority of people who have a joint replacement achieve an improved quality of life through greater independence and freedom from pain. However, an artificial joint can’t totally replace the original, natural joint. That’s because an artificial joint lacks the sensory “feedback” of a natural joint during movement. This reduces the range of motion and flexibility a person once experienced with the healthy joint.

A joint replacement generally will last for 10 to 15 years. Therefore, people who have a joint replacement in their 30s, 40s, or 50s can expect to need at least one more replacement surgery down the road. New designs and materials on the market may make artificial joints last even longer.

To help prevent joint problems, it’s important to avoid excess weight, avoid smoking, and stay fit with regular exercise.

Dr. John Lesko is an orthopaedic surgeon who specializes in hip and knee joint replacements. He is on staff at Columbia St. Mary’s and the Orthopaedic Hospital of Wisconsin. For more information, call 262-243-3100.


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