Joint Resolution

man and woman in the park on a fall day

Americans undergo a million hip and knee replacement surgeries each year

WRITTEN BY Skip Johnson

Just 30 years ago, anyone facing a knee or hip replacement would have spent at least a week in the hospital. Today, it can be done as an outpatient procedure. “Thirty percent of my patients go home the same day as the operation,” says Roper St. Francis Healthcare orthopaedic surgeon Dr. Scott McDermott. “Those who don’t go home usually spend a night in the hospital and are home before noon the next day.”

Despite being one of the most common orthopaedic procedures, arthroplasty, the medical term for joint replacement, is a last-resort option. Prior to performing such a surgery, doctors will try anti-inflammatory medications, topical creams, braces, physical therapy and injections including steroids or other substances—“anything to make the patient feel better,” says Dr. McDermott. “These conservative treatments usually work well at first, but eventually the arthritis progresses. When it starts to disrupt quality of life, surgical treatment may be the best decision.”

Dr. McDermott suggests patients start by talking to their primary care doctor, who will then recommend an orthopaedic specialist. If the specialist agrees that surgery is appropriate, the patient typically meets again with their primary care doctor to be medically optimized for surgery. (This simply means controlling any medical conditions to reduce the risk of postoperative complications.)

The surgery lasts about an hour or two, and then the patient is usually released to go home. “Immediately after surgery, patients are fully able to put 100 percent weight on the joint. The next two weeks are the toughest, but most pain resolves within four to six weeks, with noticeable gains every day,” continues the doctor. Complete recovery may take up to three months, with subtle improvements, including reduced scarring and relief from nighttime discomfort, continuing for up to a year. “Hip and knee replacements are among the most gratifying surgeries with regard to patient outcome.”

Who Needs Arthroplasty?
People with severe arthritis that no longer responds to conservative treatments are candidates. Some risk factors are out of our control, while others can be reduced with a healthy lifestyle:

Weight: Arthritis & Rheumatology reports that weight-loss strategies may reduce the need for knee replacement surgery by as much as 31 percent.

Overuse/Trauma: Occupational and sports overuse can accelerate osteoarthritis. BMC Musculoskeletal Disorders reports that 13.6 percent of osteoarthritis patients undergo at least one joint replacement surgery.

Age: “Joints are like cars—the more miles put on them, the more they wear out,” says Dr. McDermott. The average age for replacing a hip is 65 and a knee is 66, reports the American Academy of Orthopedic Surgeons.

Sex: A study in the New England Journal of Medicine found that the estimated potential need for arthroplasty among women was double that of men.