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Spokane, Washington  Est. May 19, 1883
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If joint pain persists, replacement might be the answer

Dr. Alisa Hideg

I have osteoarthritis in one of my knees. That is the name for wear and tear to cartilage, the substance cushioning the ends of bones. My knee grinds, is painful at times and is not as dependable as my other knee. As I age the cartilage in the knee will wear out more and someday I may need knee replacement. Previous fractures, other injuries and some health conditions can also cause painful damage to joints.

Orthopedists who do joint replacement surgeries often recommend trying other ways of improving joint pain before considering surgery. Sometimes joint pain improves by strengthening muscles around the joint. Physical therapy and regular exercise strengthen muscles and reduce stress on joints. Maintaining a healthy weight reduces strain on knees and hips. Supplements and prescription and nonprescription medications are frequently used to reduce inflammation and alleviate joint pain. Cortisone shots into affected joints decrease pain, but are only used a limited number of times because cortisone can ultimately worsen joint damage. Injection of a synthetic lubricant in the joint is sometimes helpful.

Even if you try these things, there may come a time when you have more pain than you can tolerate, your joint pain interferes significantly with your ability to stay active, and medications and supplements no longer seem effective. At that point, you may want to consider joint replacement surgery.

Joint replacement can ease or eliminate pain in a damaged joint, improve range of motion and increase activity level. Hips, knees and shoulders are the most commonly replaced joints. These are the joints under the most stress and often the fastest to wear out in our bodies.

Depending on where and how severe the damage is, an orthopedist may recommend partial or total joint replacement surgery. During the surgery, damaged bone and cartilage are removed and replaced with similar shaped components made of metal, plastic or ceramic.

After surgery, you will likely be encouraged to begin moving the new joint within 24 hours. Physical therapy after surgery is an important part of the healing process. As your pain decreases and you feel up to increased physical activity, talk to you doctor to see if there need to be any limitations on your activity.

Due to improvements in technology and materials used for artificial joints, some can function up to 20 years. Your age, health and activity level have a lot to do with whether you will ever need a second joint replacement surgery, called joint revision surgery.

All surgeries involve risk, and your doctor will talk with you about this before you decide whether to have joint replacement surgery. Complications of joint replacement include infection, blood clots, nerve injury, and loosening or dislocation of the joint.

The healthier you are before surgery, the faster your recovery will be and the lower your risk of complications. If you smoke, quit to improve your circulation and speed up the healing process. If you are overweight, your doctor may recommend losing weight before the surgery to make the surgery easier to perform and improve your rate of healing. Strengthen muscles around the joint you are going to have replaced. Physical therapy and/or a home exercise program is often recommended before and after surgery.

Many good friends and patients of mine have had joints replaced and are very happy with the reduction of pain and increased movement afterwards. Thankfully, I am not there yet. I take good care of my knee, exercise and stay as healthy as I can, but I am glad to know that if I ever do need it, the option for joint replacement is there.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.
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