By last summer, Joan Chiverton had endured nearly three years of knee pain. She’d had enough.
“I love to walk and I’m a very active person, and I’d have to stop after every couple of blocks and take a break,” said Chiverton, an illustrator who lives in New York City.
Her doctor recommended she have a knee replacement procedure. Chiverton agreed, although she was nervous about undergoing surgery.
Each year, more than a million Americans make the same decision, having a knee or hip replaced because arthritis or injury has left the joint so painful and stiff that it interferes with their daily life.
“They get what I call ‘tunnel life,’ when they give up all the extra things they enjoy doing, and they only do what they need to do to get by,” said Dr. Scott Martin, associate professor of orthopedic surgery at Harvard Medical School.
Getting a new joint can bring you out of the tunnel and back into your normal routine. But before you embark on surgery, there are other, less invasive therapies you can try.
STEPS BEFORE SURGERY
“In the interim, especially for knee and hip arthritis, we can give them steroid injections when they get pain flares,” Martin said. Steroids reduce inflammation, and with it pain, and they work for four to six months. With this kind of stopgap measure, “We’re trying to buy the patients time and control their pain,” he said.
One of the most effective ways to relieve joint pain doesn’t involve medication or surgery. Simply losing a few pounds can take enough pressure off the joint to delay the need for a replacement procedure.
“It’s also important to keep the muscles strong, because the muscles will dampen the stresses that would otherwise go to the joint,” Martin said. Non-impact exercises – such as riding a bicycle or elliptical machine, swimming, and walking – work the muscles without straining the joints. A physical therapist can help you learn the right exercises.
If you’ve tried injections and exercise and your joints still bother you, it may be time to consider surgery. Yet you don’t have to jump straight into a total knee or hip replacement. Less invasive options are also available.
Osteotomy cuts and reshapes bones around the knee or hip to relieve pressure on the joint. You may be a good candidate for this procedure if you’re age 60 or under, you’re very active, and you have damage on only one side of the joint. An osteotomy can delay the need for a total joint replacement, but it may not relieve pain as effectively.
Partial knee replacement removes only the damaged part of the knee, leaving the healthy cartilage and ligaments intact. It’s most appropriate for people who are not overweight and who have arthritis in just one part of the knee.
Joint replacement surgery is a big step, and it carries risks like infection, nerve injury and loosening of the implant. When making the decision to undergo a joint replacement, here are a few important questions to ask your surgeon:
1. How many of these surgeries have you performed? What is your success rate?
2. What complications can occur?
3. What kind of implant will you use?
4. Have there been any problems reported with the type of implant you plan to use?
5. How much pain can I expect after the surgery? What will you give me to relieve the pain?
6. What kind of rehab will I need?
7. How long will it take me to recover?
To ensure the best possible outcome, one of the most important things you can do before your surgery is to get into good shape.
“If your BMI is high, losing weight can decrease your risk of blood clots,” Martin said. “You also want to get as strong as you can. If you start out weak, it takes a lot longer to recover.”
Though Chiverton was not overweight to start, her doctor recommended that she lose a few pounds with a presurgical fitness program that included physical therapy and swimming.
“I think that because I went into this experience in good shape, it helped me get through it as easily as I did,” she said.
LIFE WITH A NEW JOINT
It can take anywhere from eight to 12 weeks to fully recover from a joint replacement. If you don’t have someone to help you during that time, you may need to go to a rehabilitation facility. Otherwise, you can stay at home and get regular visits from a nurse and physical therapist to help you recover.
Your new joint won’t necessarily give you the ability to run marathons, but it should improve your mobility significantly.
“A lot of patients will get back to where they were years before,” Martin said. And it’s the best intervention to relieve the pain of knee osteoarthritis.
About six weeks after her surgery, Chiverton was back on her feet, walking without a cane.
Although joint replacement isn’t for everyone, for her, the decision to have this surgery was the right one.
“I can walk miles now. Friends tell me that my whole demeanor is different,” she said. “It made a big, big difference.”