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For Your Health: How to know if it is time for a total joint replacement

by St. Mary's Hospital | March 7, 2023 at 4:00 a.m.

Do you suffer from knee, hip or shoulder pain? How do you know if the pain warrants a surgical solution?

The most important factor when deciding if a joint replacement is right for you is determining how much it hurts and how it is affecting your life.

Ask yourself these questions:

Can I no longer complete routine daily tasks without help?

Do I have significant pain, which keeps me awake at night despite use of medications?

Are the side effects of the pain medication worth it, especially if they do not effectively help manage the pain?

Does my pain keep me from being able to walk, bend over or dress myself?

Does resting not relieve my pain?

Have non-surgical interventions not improved my symptoms?

Has my surgeon stated that less-complicated surgical procedures are unlikely to help me?

Is osteoarthritis wearing me down physically, mentally and emotionally?

Has imaging shown advanced arthritis and/or significant joint damage?

If you answered yes to any of the above questions, it may be time to schedule an appointment with an orthopedic surgeon to discuss your options.

Prior to having a joint replacement surgery, non-surgical treatments have typically been exhausted due to the guidelines established by Medicare and commercial insurance payors.

Non-surgical treatments include:

Non-steroidal anti-inflammatories (Ibuprofen, Aleve, etc.).

Physical therapy.

Cortisone injections.

Lubricating injections.

Other surgical interventions.

The journey for a joint replacement begins with an orthopedic evaluation to determine the best treatment plan for an individual patient. Patients seeking a total joint replacement for a shoulder, hip or knee suffer from debilitating arthritis or from a past injury that now requires replacement.

Patients who benefit from joint replacements are those who have severe pain or stiffness in the joint, which limits everyday activities; such as:

Dressing, cooking, cleaning, walking, bending, climbing stairs, getting in or out of chairs or even sleeping.

Use of a cane or walker.

Moderate or severe pain in the affected joint even while at rest during the day or night.

Chronic inflammation and swelling that does not improve with rest or medications.

Failure to improve symptoms with non-surgical treatments.

Deformity with either bowing out of the knee or knock-knee.

Hip stiffness that limits the ability to move or lift the leg.

Loss of motion and/or weakness in the affected shoulder.

After the non-surgical requirement is attempted, a collaborative appointment is held to determine if a joint replacement will be of benefit to the patient's quality of life.

Those in the collaborative appointment are the orthopedic surgeon, the patient and the designated support person who will be with the patient throughout the process.

Following the decision to have a joint replacement, the patient will need to have clearance from the primary care provider and a cardiologist if the patient has a cardiac history. Some orthopedic surgeons require dental clearance.

Why dental clearance? Studies show that an important way to reduce the risk of infection following joint replacement surgery is to have a routine dental cleaning and completion of any major dental procedures prior to surgery.

To ensure an optimal outcome following joint replacement surgery, the following guidelines have been established by the American Association of Orthopedic Surgeons:

Patients should have a Body Mass Index (BMI) less than 40.

Blood sugar should be less than 6.5. Levels higher than this can lead to less favorable post-operative outcomes and higher complication rates.

The AAOS also recommends patients avoid opioids prior to surgery, as studies have shown pain is harder to control post-operatively and there are increased risks of complications.

When patients decide to have joint replacement surgery, they dream of putting pain and movement limitations behind them and returning to an active lifestyle. Patients should have a realistic expectation from a joint replacement.

Many patients will experience a dramatic reduction in the amount of pain and significant improvement in performing common activities of daily living over time. Decreased pain should be a realistic expectation following surgery.

However, the patient will have work to do to regain strength in the operative extremity. The orthopedic surgeon will replace the damaged joint with a prosthetic joint but physical therapy will put the patient on the fast track to eliminating pain and regaining mobility.

Realistic activities following joint replacement include unlimited walking, swimming, golfing, driving, light hiking, biking, dancing, and other low impa`ct activities.

Laura Sicht, RN, BSN, is the Program Coordinator for Orthopedics & Spine Surgery at SSM Health St. Mary's Hospital. She helps patients navigate the various requirements for orthopedic and spine surgeries as well as provides education to patients. Those with questions or seeking to make an appointment for a joint replacement may call 573-681-3031.

Print Headline: For Your Health: How to know if it is time for a total joint replacement


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