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Exploring Your Options Before a Total Joint Replacement

January 31, 2024

A woman receives physical therapy for osteoarthritis.

When pain in your knee or hip becomes too great to bear, people often look to surgery for relief. But there are other treatment options that you can try before considering surgery.

“Following total joint replacement surgery, pain is often completely eliminated, and mobility is restored,” says Angelo Mannino, MD, an orthopedic surgeon at Atlantic Health System. “But before undergoing this type of procedure, we make sure patients have explored nonsurgical options for relief and improved function, because these can stave off the need for surgery.”

What Is Osteoarthritis?

If you’re experiencing pain, swelling, stiffness, or limited range of motion in your knees or hips, there’s a good chance it’s from osteoarthritis — a degenerative joint disease that causes cartilage loss. Your orthopedist can confirm it by taking an X-ray in their office. It is common in people over age 50, more prevalent in women than men, and more commonly affects those with diabetes, obesity or heart disease.

“Arthritis develops mainly from wear and tear on your joints,” says Dr. Mannino. “Injury, trauma, infection, and even genetics can also trigger cartilage breakdown — and weight also plays a major role.”

Dr. Mannino explains that every time you sit, stand, or use stairs, you place five to six times your body weight through your knee joint. Put another way, one pound of weight loss is equal to five to six less pounds of weight — or force — on your knees.

What Are Treatment Options?

Although osteoarthritis is irreversible, there are several treatments that can alleviate discomfort and improve range of motion. Treatment typically progresses in three stages:

  1. Non-Pharmacologic Options
     - Exercise and stretching
     - Physical therapy
     - Weight loss
     - Acupuncture and chiropractor
     - Heat and cold therapies
     - Orthotics, braces, canes
  2. Pharmacologic Options
     - Tylenol
     - NSAIDs (non-steroidal anti-inflammatory) e.g., Advil®, Aleve®
     - Topical, anti-inflammatory creams (Voltaren® gel)
     - Pain medications (tramadol, opioids)
     - Joint injections (steroid, gel, platelet-rich plasma [PRP])
     - Supplements (glucosamine, turmeric, CBD oil)
  3. Surgical Options
     - Total or partial joint replacement surgery

Are You a Candidate for Joint Replacement Surgery?

If physical therapy, injections, and medications haven’t worked and your doctor determines that you’re healthy enough to undergo an operation, you are a candidate for knee or hip replacement surgery.

“This decision is yours, based on your level of pain,” says Dr. Mannino. “If the pain is debilitating enough to impact your quality of life when you’re walking, chasing grandkids, or playing pickleball, then it may be time to discuss surgical intervention. It is your choice when to do it, but only after you’ve tried everything else.”

What Is Involved?

Dr. Mannino explains that surgery is just a part of the process. The real work is the rehabilitation after the surgery — and it’s also the most important. Patients must not only be physically ready but, just as importantly, they must be mentally ready to dedicate time and effort to their healing.

Patients are up and walking the same day with intensive physical therapy for about eight to 12 weeks. Within three months, they’re usually back at work and back to their active lifestyle without any pain.

“We remove the arthritic cartilage in the knee or hip and replace it with a metal and plastic implant that works just like the original joint,” says Dr. Mannino. “These are highly successful procedures that can last 25 years. But a total joint replacement surgery is an elective surgery. It’s not a lifesaving surgery. It’s all about improving your quality of life and getting you back to where you were before you had pain.”

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