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Don’t wait too long for joint replacement

Posted Apr 28 2009 1:41pm

The conventional medical advice has been to delay joint replacement as long as possible so as to avoid a second operation when the initial artificial joint wears out. Historically, the need for revision started at about ten years and progressively increased in need by the 20th year. This strategy of waiting no longer makes sense. First of all, advances in technique and technology have extended the survivorship of implants to 20 –25 years with very satisfactory outcomes. Equally important, Patients with the most severe and long-standing disabilities at the time of their surgery fare much worse than patients who undergo surgery when they are less impaired. If the arthritis related limitation dates back over five years before surgery, the rehabilitation is much more painful and drawn out. If one measures outcomes of those who wait too long, pain medication usage and limited functional capacity continues to a much greater extent at one month and a year when compared to those who have more timely joint reconstruction.

Recent advances in implant design including gender specifics and more durable plastics have markedly improved outcomes and lessened the concern of a subsequent procedure. And new evidence of the safety risks from popular anti-inflammatory drugs make for unease about staying on such drugs for years at a stretch. When your life is dictated by the limitations from your arthritic hip or knee, the time has come to consider replacement.

What are the criteria?

  1. The pain makes it impossible to sleep through the night
  2. Medication doesn’t alleviate the pain
  3. Anti-inflammatory drugs have produced unacceptable side effects such as GI bleeding or ulcers, increased blood pressure, fluid retention, or reduced kidney or liver function
  4. Interference with activities of daily living
  5. Alteration in you vocational or recreational undertakings

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