Do I need a Total Hip or Total Knee Replacement?

This is a question that I get asked with some regularity and like most answers, it depends. Deciding to undergo surgery is a huge and personal decision and depends on much more than just the condition of your joints. While these procedures are overwhelmingly safe and effective there are a number of factors to consider before scheduling an operation. So let’s go over some of the things I discuss with my patients when deciding if surgery is right for them.

X-RAY/MRI – If you are considering a total hip or total knee replacement you have more than likely had an x-ray and/or MRI. If the imaging does not show advanced arthritis of grade 3 or 4 I would hold off on surgery. (arthritis is characterized in 4 grades, 1 being the mildest and 4 being the most advanced) If the images do not show significant cartilage damage, it is quite possible that your pain is coming from something else. If your images do show advanced arthritis you are a candidate for these procedures, but by no means is it definitive that you should have this surgery. In many cases, people can have significant arthritic changes on images but have little or even no symptoms. So just because the X-Ray/MRI is positive doesn’t mean you couldn’t possibly feel better with a more conservative approach.

PAIN INTENSITY – Surgery is a big decision and while generally safe there are risks involved. Your pain level should be significant for you to consider surgery. While pain is subjective, anyone with pain less than 5/10 would be well served to consider other options such as physical therapy, anti-inflammatory medications, or even steroid injections before surgery. Surgery should not be considered as a remedy for mild or moderate pain.

PAIN CONSISTENCY – If your pain comes in recurrent flare-ups with weeks or months in between where you feel generally well surgery may not be right for you. Rather you should be working with your physician and physical therapist to see if you can figure out the causes for these flare-ups. They may be a result of an activity, systemic changes, or even stresses in your life that are not physical at all. If the primary cause for pain is a degenerated joint, that pain will tend to be much more frequent and consistent.

PAIN DURATION – If your pain only began a few weeks ago, or even months you should not consider surgery at this point. Arthritis does not come on rapidly, it slowly builds over time. If you developed pain suddenly and recently had an X-Ray indicating arthritis, I assure you the X-Ray would have looked identical a few weeks earlier when you were not in pain. Pain can come on for a great variety of reasons, so give yourself time to see if you can recover without the need for surgery.

FUNCTIONAL GOALS – If you have advanced arthritis and consistent pain with certain activities, but you are fine with cutting those activities out of your life, then you can very reasonably get by without surgery. Remember arthritis is not a life-threatening condition, so if you prefer to manage your symptoms by accommodating the pain and changing your activities that is a very reasonable course of action. It is your choice to make.

OTHER TREATMENTS – Surgery should never be your first choice. Before you decide on surgery you should have already tried a course of physical therapy or maybe multiple courses with different therapists if the first was not successful. You can also consider medications or injections to manage symptoms. Make sure you also try activities outside of the medical world including gentle yoga, Thai Chi, meditation, or just regular cardiovascular exercise. I have seen even the most severe cases be able to avoid surgery by making a few lifestyle changes and committing to improving their physical function.

FEAR – There is always some level of fear before surgery, and that is appropriate. It is a major decision and while statistically very safe and effective there is the possibility of complications that can result in long-term impairments. I have encountered some patients who are adamantly opposed to surgery that I believe would benefit from it. They would rather live with whatever pain they have than go under the knife. After I make sure they understand all of the risks and benefits and the likelihood of success vs complications, if they are still opposed, I respect those wishes and do my best to improve and accommodate their condition. However, fears are often based on misconceptions about surgery procedures and outcomes. So, make sure you speak with your surgeon, family doctor, or PT to fully understand the pros and cons and then make the decision that feels right for you.

SUPPORT – While recovery from these surgeries is ever faster as techniques improve, in even the best circumstances you still will not be 100% for at least 6 months. Consider the support system you have to help you postoperatively if you need it. It can be a family member, neighbor, or friend. It’s a tough thing to go through alone so lean on the people around you and let them know you might be calling on them for help for a little bit.

There is rarely a definitive right or wrong to whether you should undergo a hip or knee replacement. Gather as much information as you can, try a variety of other medical and lifestyle solutions first, have discussions with your loved ones, and then make the decision that has the greatest likelihood to let you lead the life you want.