By Beth Lueders
Hobbling around with a swollen knee or stiff hip may soon be passé for elders. Thanks to surgical advancements, people are seeking medical help sooner to alleviate chronic pain and receive artificial joints — some of them are in their 50s or are even younger.
Every year millions of people worldwide undergo total joint replacement surgery to correct a damaged or arthritic joint. A joint forms the connection between two or more bones to add support and help you move. The weight-bearing hip and knee joints see ongoing wear and tear and are replaced most frequently. The shoulder, ankle, wrist and elbow are other joints that are well-known to orthopedic surgeons.
Joint replacements are among the most common elective surgeries. People are seeking joint replacements earlier in life, in part because people are staying more active as they age and they want a better quality of life through retirement. A rise in obesity also places greater stress on aging joints.
Dr. Ritesh Shah, an American Academy of Orthopaedic Surgeons board-certified orthopedic surgeon with the Illinois Bone and Joint Institute of metropolitan Chicago, notes that on average people receive a total joint replacement between age 64 and age 66. “People are enjoying activities at an older age now and want to enjoy their quality of life,” Dr. Shah said. “The ability to ambulate becomes very important to a good quality of life. Significant joint pain is a significant disruption of life and people don’t want to live that way anymore.”
When Is Joint Replacement Advised?
Prominent joints in the body can become severely damaged through the aging process, everyday wear and tear, and injuries. Or conditions like osteoarthritis, rheumatoid arthritis, bursitis, fractures, gout, tumors and other diseases can comprise the connections between bones.
Joint pain can be mildly irritating to chronically debilitating. Your doctor may recommend surgery if you experience chronic inflammation, limited movement, joint deformity, or when non-surgical treatments such as physical therapy, medications and injections have not provided sufficient relief from continual pain.
Risks and Benefits of Joint Replacement
During a replacement operation, damaged cartilage that cushions the joint surface is removed. Parts of the joint are also removed and fitted with a titanium, ceramic or plastic prosthesis to replicate normal joint movement. Total joint replacements do not last forever, and patients may eventually need a revision to their joint implants, but Dr. Shah notes that with today’s improved surgery methods and stronger, cement-less materials, replacement joints are now lasting up to 15 to 20 years in knees and up to 20 to 30 years in hips, depending on the activity level of the patient.
Each joint replacement surgery candidate is evaluated for potential risks and complications. A person’s general health and family health history are part of a comprehensive pre-surgery assessment. As with any surgery, conditions such as heart disease, poorly controlled diabetes or a weak immune system can elevate risk. Possible joint replacement surgery complications include infection, blood clots, nerve injury and the prosthesis loosening or dislocating. For the million-plus people each year nationwide who choose joint implant surgery, the benefits of pain relief, better movement and strength, and engagement in sports and social activities outweigh the possible risks.
Post-Surgery Recovery and Care Tips
Recovery and rehabilitation for joint replacement varies with each individual, but in general, following the doctor’s instructions will speed healing. Most patients will experience pain in the replaced joint as tissues heal and the body adjusts to strengthening surrounding muscles that have been weak from inactivity. For new knee joints, the doctor may prescribe a continuous passive motion (CPM) device for patients to use at home to help the knee learn to flex and extend. Cryotherapy machines and packs that employ ice to reduce pain and swelling are also used in post-surgery care. The first weeks at home may also require the use of assistive items such as handrails, a shower bench, raised toilet and long-handled reacher.
New Horizons for Joint Replacement Surgery
While traditional joint replacement surgery has meant months of recovery including pain, opioid medications, limited mobility and intense rehabilitation, increasingly orthopedic surgeons are employing innovative surgery techniques to significantly advance patient outcomes. These contemporary technologies and techniques include shifting muscles out of the way instead of cutting into them or disturbing too much bone. Prefabricated cutting block molds from 3-D magnetic imaging help eliminate the need for more invasive bone separation, rods and pins. Digital cameras, optical navigation and robotic-assisted systems in the operating room help ensure precise positioning of the joint implants and speed total surgery time.
Based on healthcare coverage and upfront training and equipment costs for surgeons, hospitals and surgery centers, these advancements in joint replacements and post-surgery recovery are not yet available for every patient, but the outlook is promising.
“My oldest patient was 81 and we’ve had multiple people in their late 70s and early 80s have outpatient surgeries,” Dr. Shah adds. “The main thing to consider with an elder is identifying safety by seeing if medical problems are compatible with having surgery and anesthesia and then making sure the home situation is appropriate.”