If you have advanced end-stage joint disease (usually of the knee or the hip) and have exhausted all other non-surgical treatments, but are still experiencing functional decline and disabling pain, you may consider joint replacement surgery. For people with progressive diseases such as rheumatoid arthritis (RA), total joint replacement is one of the safest and most reliable treatments in any area of medicine and can last 20 years or more, according to the American College of Rheumatology.
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Is joint replacement appropriate for you?
While there is no set upper age limit for joint replacement candidates, the decision is typically based on your general medical condition and fitness for surgery, and how much your arthritis affects your quality of life.
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In some cases, joint replacement surgery may not be necessary because arthritis medications, exercise modification to low impact activities (e.g. swimming, walking, biking, etc.), weight loss, nutritional supplements, and joint injections can help you live with your arthritis for as long as possible.
Tips for optimal recovery
If it is decided that joint replacement surgery is your best bet, there are a few things you can do to ensure your road to recovery after surgery is as smooth as possible.
Here are some lifestyle changes that might improve your chances of a good outcome if you're one of the estimated one million Americans having total hip or knee replacement surgery this year, according to an expert.
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Lose weight safely through diet and exercise before surgery, says orthopedic surgeon Dr. Matthew Abdel. The target body mass index (BMI) — an estimate of body fat based on weight and height — is less than 40, but the closer you can get to a BMI of 25 to 30, the better, according to Abdel, who specializes in hip and knee replacement at the Mayo Clinic in Rochester, Minn.
Even losing 20 pounds before hip or knee replacement surgery improves outcomes, he says. Here are some of his other suggestions:
- Stop using cigarettes, chewing tobacco, cigars and all other nicotine products at least six weeks before having surgery. After surgery, do not use nicotine products.
- Stop taking narcotic pain medications at least two weeks before surgery.
- If you have diabetes, make sure you have it under adequate control before surgery. That's defined as hemoglobin A1C less than 7.5. You also want excellent blood sugar control in the time around surgery.
Some lifestyle changes do not improve outcomes after hip and knee replacement surgeries, Abdel notes. These include herbal supplements and vitamins, wound creams and electrical stimulation devices.
The jury is still out on whether other measures before surgery help improve outcomes. Among them: physical therapy before hip and knee replacements and post-op physical therapy for knee replacements.
Some patients have weight-loss (bariatric) surgery before hip or knee replacement surgery, but recent research by Abdel and colleagues raises questions about that.
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The investigators found these patients had more complications than those who just had joint replacement surgery, regardless of their BMI. The complications included infection and instability and affected the success of the joint replacement surgeries.
"We think it may have something to do with the bariatric patients' underlying system, such as their gut microbiome and underlying genetic host variation," Abdel said in a Mayo Clinic news release. "Even though they lost the weight, the soft tissues and underlying collagen status were still of their original nature."
Before undergoing joint replacement surgery, it is important to talk with your primary care doctor to ensure your health is good enough to undergo the anesthesia and rehabilitation associated with the surgery.
