Getting a “new knee” or a “new hip” is a hot topic among baby-boomers. Over the past few decades, surgical methods and artificial joints have advanced to the point where at the first sign of arthritis or injury, patients often ask their doctors about joint-replacement surgery.
Although replacing a knee, hip, or shoulder with a new, man-made joint can significantly lessen pain and increase mobility, it’s important to consider other options, as well. Joint-preservation surgery is less invasive and often delivers similar results.
When joint pain arises
A major injury, such as an anterior cruciate ligament (ACL) tear, might necessitate surgery in a young adult. However, most candidates for joint-preservation surgery are in their 50s or older. This is the age when arthritis and years of wear-and-tear often start to cause pain in the hips, shoulders, or knees. For most people, physical therapy and medications provide initial relief and delay the need for surgery.
Just as other options should be considered before choosing surgery, patients and their physicians should consider joint-preservation surgery as an alternative to full joint replacement, which involves major surgery and lifelong restrictions on activity. Compared to joint replacement, joint-preservation surgery typically offers what many would consider more appealing features:
- Smaller incision. This means a faster recovery time and less chance of infection.
- Outpatient surgery. In many cases, a patient who undergoes joint-preservation surgery can go home the same day.
- No activity restrictions. After recovery and physical therapy, high-impact activities, such as running and jumping, are permitted.
- Long-lasting effectiveness. No worries about a new artificial joint wearing out.
Preserving the joint
Surgical options to preserve a joint vary based on the joint that is involved and the problem that has occurred.
- Hip: arthroscopic treatments are available for problems including labral tears, cartilage lesions (“wear-and-tear” damage) and micro instability. Arthroscopy involves two or three small incisions to make repairs using a tiny camera to guide the surgeon in the use of specialized instruments.
- Knee: the underlying problem could be a malalignment, meniscal deficiency, ligament tear, or cartilage lesions. Treatment options include osteotomy, meniscal transplant, ligament restructuring, and cartilage transplants. Note that meniscal and cartilage transplants are much different from the organ transplants most people are familiar with and do not require immunosuppressive medications.
- Shoulder: minor pain can be easier to tolerate, since the shoulder is not a weight-bearing joint. A painful massive rotator cuff tear can be treated through superior capsular reconstruction, which uses a graft to stabilize the humeral head.
Avoiding joint pain
The best strategy for joint health is to delay the need for surgery as long as possible, or even avoid it altogether. At any age, there are strategies to enhance lifelong joint health:
- Losing weight. The more a person weighs, the greater the force placed on the knees and hips with every step — and more force means more potential for pain and damage.
- Strengthening muscles. The thigh’s quadriceps and hamstrings support the knee joint, while the gluteal muscles in the buttocks and the flexors in the pelvis are important for hip movement.
- Switching to low-impact activities. Running impacts the knees heavily with each step, while walking, swimming, and biking are excellent low-impact activities.
Major joint pain does not have to be part of a person’s senior years, and neither does joint-replacement surgery. Take steps to prevent or lessen pain, and when surgery is unavoidable, be sure to discuss all options with healthcare providers to find the best treatment to match the patient’s medical problem and lifestyle.
Paul Herickhoff, MD, is an orthopaedic surgeon with Penn State Sports Medicine, located at 1850 E. Park Ave., Suite 112, State College. Call (814) 865-3566 for more information. Join Dr. Herickhoff as he discusses Non-Arthroplasty Options for Active Patients on Monday, November 13, from noon to 1 p.m. at HealthSouth Nittany Valley. This event is free and open to the public.
