One of the most common questions I answer has to do with the right time to undergo joint replacement surgery. Some patients worry about having the surgery too soon. Others are concerned about whether or not they have waited too long.
I do think timing of surgery is an important consideration. When I discuss with patients the timing of the surgery, I look at three different factors.
Quality of LIfe
The most important question I ask my patients is what their pain keeps them from doing. To me, this is the reason I treat osteoarthritis: to help patients get back to doing what they love. If the pain does not keep you from doing the things you want to do, or need to do, it is too soon for surgery.
The right time to consider joint replacement surgery is when the pain keeps you from being who you really are.
For some patients it is sports like tennis or golf. For others it is hobbies like gardening or travel or shopping. Some patients struggle with being active for the sake of their own health like daily exercises. Some want to be able to play with their grandchildren. I have had many patients who simply miss hiking in the north Georgia mountains. Others find that their pain makes it difficult for them to work.
If you pain keeps you from doing the things you love to do, then surgery is worth a discussion.
The Correct Diagnosis
As with any medical treatment, the first critical aspect to a successful outcome is to have the correct diagnosis. I can make the diagnosis of moderate to severe osteoarthritis easily made in my office. Whenever I see new patients the first I do is to check an X-ray of the affected joint. X-rays are a quick, easy test and can potentially give me a lot of information.
Osteoarthritis can be seen as narrowing of joint spaces. The joint “space’ isn’t a real space. It is actually cartilage that isn’t picked up by the X-ray and looks like a space. Joints with osteoarthritis also form bone spurs, or osteophytes, on the sides of the joint. If you would like to read more about what osteoarthritis is, please read this article.
Failure of Conservative Treatments
Once the diagnosis is made, I always discuss treatment options with my patients. The purpose of this discussion is to tailor the treatment to your specific needs. Before considering surgery I always encourage patients to try these options to see if their pain will improve without the need for surgery.
In the case of osteoarthritis, the most common nonsurgical treatment options include non-steroidal anti-inflammatory medications (NSAIDs), bracing, physical therapy, and injections.
There are two different over the counter NSAIDs, ibuprofen (Advil or Mortrin) and Naprosyn (Aleve). There are many other NSAIDs that are available by prescription. In patients who have a stomach sensitivity to these types of medications, some will try a topical NSAID called Voltaren gel. Some patients are not allowed to take NSAIDs for medical reasons and it is always important to discuss this with your medical doctor.
Many of my patients will try cortisone injections as well. Cortisone is a combination of a numbing medicine, or local anesthetic, and a steroid. Steroids are strong anti-inflammatory medications and when we inject them in a joint they can have a strong local affect. Cortisone injections can provide significant relief in pain from an arthritic joint, but will eventually wear off. Their benefits are always temporary.
Quicker Recovery with Less Pain
Since the goal is to help patients get back to doing the things they love and enjoy, my secondary goal is to help them do this as easily as quickly and easily as possible. At Northside Hospital through a collaboration between myself, our anesthesia team, nursing, and physical therapy, we have developed a protocol to help our patients get back to what they want to do and to minimize the pain associated with joint replacement surgery.
To read more about our fast track program at Northside, click here.
