Is it time for joint replacement?


By Steven Bruce, MD

Your joints support you every step of the way, every day of your life. It can be a long and bumpy road, and your joints are the primary shock absorbers. From tot to senior, they’re at work every time you walk, run, jump or boogie down.

As time passes, the cartilage in the joints begins to wear out, which causes the joint to become inflamed and painful. That pain is the calling card of arthritis. Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues.

Osteoarthritis is one of most common forms of arthritis and is a chronic condition characterized by the breakdown of the joint’s cartilage. It most commonly occurs in the weight-bearing joints of the hips, knees and lower back.

Symptoms of the disease usually come on little by little and can include:

Joint pain, which might get better with rest.

Dull, throbbing pain at night.

Stiffness and swelling in the joint.

Difficulty walking or bending the joint.

According to the Arthritis Foundation, an estimated 27 million Americans live with osteoarthritis, but despite how common it is, the cause is still not completely known. In fact, many different factors may play a role in whether or not you develop it. Also, where and when arthritis occurs can vary from person to person.

Common risk factors for osteoarthritis include:

Age. Years of wear and tear can lead to osteoarthritis, but it doesn’t mean it is inevitable.

Obesity. Research suggests excess body fat produces chemicals that travel throughout the body and can cause joint damage, meaning obesity plays a systemic, not just a mechanical, role in osteoarthritis onset.

Injury or overuse. Athletes and people who have jobs that require doing repetitive motion have a higher risk of developing osteoarthritis due to injury and increased stress on certain joints.

Genetics or heredity. Genetics play a role, particularly in the hands. Just because you have one of these inherited traits, doesn’t mean that you are going to develop osteoarthritis. It just means that your doctor should check you more closely and more frequently for signs and symptoms.

Muscle weakness. Studies of the knee muscles show that weakness of the muscles surrounding the knee can lead to osteoarthritis. Strengthening exercises for thigh muscles are important in reducing the risk.

Many treatment options are available. Your doctor will likely recommend conservative management options in the early stages of arthritis, such as over-the-counter or prescription anti-inflammatory drugs known as NSAIDs. Cortisone injections, another form of treatment, place a concentrated dose of anti-inflammatory medication directly into the joint. Taking NSAIDs for extended periods or using cortisone repeatedly however, comes with their own issues.

Physical and occupational therapy are also available, which includes exercises that strengthen the muscles surrounding the joint and education to improve body mechanics, posture, mobility, daily living skills and safety. Additionally, lifestyle modifications can be beneficial, such as nutrition changes that add anti-inflammatory foods and weight loss to ease the strain that added pounds place on joints.

These treatment options can be very effective in managing arthritis pain; however, in some advanced cases, the pain inevitably warrants surgery. Knee, hip, shoulder and more recently, ankle replacement procedures, can give arthritis sufferers a new lease on life.

The synthetic materials used to replace joints have evolved over the years, as have the surgical procedures. Today, a replaced knee or hip will last far longer and function better than earlier designs; and technology combined with good old-fashioned physical rehabilitation means shorter recovery.

Living with and managing arthritis is a journey. Don’t live with pain. Evaluate your options, talk with your doctor and make a step toward the solution that works best for you.

Originally from Chicago, Steven Bruce, MD, is a board-certified orthopedic surgeon at PeaceHealth Medical Group’s Orthopedics with special interests in knee and hip replacement, arthroscopic knee surgery and fracture care. 

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