Created on: 06/06/07 - Email to friend - Print Page

How Do You Know It's Time for Surgery?

How Do You Know It's Time?

Questions to Ask Your Doctor

Types of Replacement Parts

Preparing for Surgery

Your Hospital Stay

Recovery at Home

Getting Back to Normal

Surgery Message Board

Discuss Surgery With Others

View Surgery Animations

Additional Resources

Fact Sheets from the AAOS

How do you know if it is time for joint replacement surgery? Jeffrey T. Nugent, M.D., orthopaedic surgeon at Piedmont Hospital in Atlanta, Ga., and member of the American Association of Orthopaedic Surgeons (AAOS) as well as the American Association of Hip & Knee Surgeons, says if you are having any of these signs, you need to speak to your rheumatologist or orthopaedic surgeon about the possibility of joint replacement.

If you are unable to sleep at night because of the pain.

If you've tried a series of different medications that don't help alleviate the pain or the medication you have been on no longer works.

If you feel that the pain from your arthritis is keeping you from regular outings such as visiting friends, going shopping or taking a vacation.

If your activity is restricted to the point where you have trouble getting out of a chair, going up stairs, getting off the toilet or getting up from the floor.

Other factors that your doctor will consider before advising joint replacement surgery include:

General Health: Your doctor will look to see if you have hypertension, heart disease or lung disease, as these will add to the risk of surgery. If you have rheumatoid arthritis, diabetes mellitus, certain skin diseases such as psoriasis or you are on immunosuppression drugs, you may be at higher risk of infection from surgery.

Weight: Dr. Nugent tells his patients who are over 300 pounds that they must be under 300 before he'll do surgery. He says the people who lose the weight have an easier recovery from surgery and their artificial joints last longer. Most of them find that once they have the surgery, it is easier to keep the weight off. "Many people put weight on because their arthritis has limited their activities," says Dr. Nugent.

Age: Dr. Nugent limits the number of surgeries he performs on people over 95 years old because the surgery generally presents more of a risk for them than the deteriorating joint. He also discourages teenagers and those in their early twenties from proceeding with total hip or knee replacement except as a last resort as with severe debilitating rheumatoid arthritis or avascular necrosis from previous injury. "Many of these younger patients need to try all options short of surgery for relief," says Dr. Nugent. Total joints wear out faster in young active patients and too frequently repeated surgeries are necessary in these cases. According to Dr. Nugent, "It is hard for younger kids and adults to limit their life styles. They try to keep up with their peers and that wears down the joint fast."

Bone Density: If you have severe osteoporosis or a history of stress fractures, the doctor will want to treat this before going into surgery. You may also wish to carry out long-term treatment for many years for these conditions to protect the total joint bone anchorage. Very thin bone may also prompt the surgeon to use cement for fixation rather than non-cemented materials.

Bone and Joint Deformity and Stiffness: Deformities around the hip or knee may also require bone osteotomy (or bone cut) as best treatment for younger individuals (particularly those who are overweight). Very stiff joints also pose a significant problem in that many of these patients continue to have a certain degree of stiffness following rehabilitation. Extremes of deformity and stiffness make the hip or knee replacement more complex; however, good results are normal in these patients.

Nutrition: This is particularly important with elderly people who may not get an adequate supply of protein, eat a balanced diet, or lack the proper vitamins and minerals in their meals. Your doctor may prescribe supplements or a visit to the dietitian to make sure you are as healthy as you can be before surgery and during recovery.

Jeffrey T. Nugent, M.D., is an orthopaedic surgeon at Piedmont Hospital in Atlanta, Ga., who specializes in knee and hip replacement surgery. He has served on the Arthritis Today Medical Advisory Board and reviewed the new Arthritis Foundation book, All You Need to Know About Joint Surgery. Order your copy today and get more great advice on how to handle joint surgery.