The pain of osteoarthritis can be debilitating. As we age, the cartilage that cushions our joints naturally starts to wear down. Osteoarthritis is a degenerative condition that speeds up cartilage loss, damaging the joint surface and causing the bones to rub together. This creates inflammation and pain.
In the case of knee osteoarthritis, it is the ends of the femur (thigh bone), the tibia (shin bone) and the patella (kneecap). And, in hip osteoarthritis, the head of the femur and the socket that it sits in (the acetabulum) become inflamed. There is also ankle, elbow and shoulder arthritis, that occurs in the same way.
When to consider surgery
Surgery to replace the damaged joint is normally only an option once other, less invasive treatments have been exhausted. This is because surgery carries the risk of complications. If you are suffering from mild to moderate arthritic pain, less invasive procedures like platelet rich plasma injections, in-shoe cushioning orthotics, braces, pain-killers and physiotherapy are normally offered first.
The pain of osteoarthritis can have a significant impact on quality of life and as it becomes more acute, and intrusive in your life, you may be offered total joint replacement.
This type of treatment is normally offered to:
- People with severe osteoarthritis
- Anyone whose quality of life is significantly impacted by their symptoms, for instance, pain that even occurs at rest or not being able to walk more than 30 minutes
- Anyone for whom less invasive procedures are ineffective or have ceased to work
However, not everyone is suitable for this type of treatment. Surgery may not be an option if you have had infections in the arthritic joint in the past.
There are pros and cons to knee or hip replacement that you should consider carefully before deciding whether or not to have surgery.
Pros
Joint replacement surgery can provide long-term relief from the pain and stiffness of osteoarthritis. By taking away the damaged or diseased joint and replacing it with an artificial one, it is possible to alleviate many of the symptoms and restore mobility. On average, hip and knee replacements last 15-20 years if looked after properly. Depending on your age, this may mean the remainder of your life being free from the pain of osteoarthritis.
Cons
Joint replacement surgery is a major operation. You will normally be in hospital for one to three days and you may need a walking aid for around two weeks after surgery. You will not be able to drive for 2-4 weeks. It can take up to two years to fully recover from knee replacement surgery.
Complications associated with surgery are rare but can include:
- stiffness and swelling
- never damage (giving numbness or weakness to the foot)
- blood clots or deep vein thrombosis
- ongoing pain in the affected joint
- blood loss
- fracture of surrounding bones or dislocation
- risks from the anaesthetic
Outcomes
In more than 90% of people, total joint replacement brings relief from pain and restores lost mobility. However, the success of the operation depends on the health of the rest of the joint and “prehabilitation” – exercising the joint before the surgery to make the joint stronger, will likely have a very positive effect on your outcome.
If you have previously undergone joint surgery or you have had infections in the joint or if your joint anatomy is abnormal, you will need to talk to your orthopaedic surgeon who can advise you.
