Joint pain is something that frequently occurs as we age. There are many different causes of joint pain, but osteoarthritis is one of the most common.

As some people age, they can wear out the cartilage ⁠— the smooth, shock absorbing part of the joint between the bones. When that happens, the bones get closer together, and they can start to rub each other, which can be excruciatingly painful. A typical patient with osteoarthritis will experience pain, stiffness and loss of range of motion, which will eventually lead to loss of function and independence.

Most Common Joint Replacements

All joints can develop osteoarthritis. Knees are the most commonly replaced joints, followed by hips and then shoulders. Knees are twice as likely to wear out compared to hips. Most patients suffering from osteoarthritis need a joint replacement between their 50 and 70s.

How to Prevent Wear in the Joints

The most important way to prevent joint replacement is to maintain a healthy body weight. Certain activities, such as going up and down stairs and kneeling can put up to four times a person’s body weight on the joints.

The second most important method to prevent joint wear is to keep the muscles around the joint strong. This would involve strength training and stabilization techniques.

Despite these efforts, some patients still will need a joint replacement. There is also a genetic component to osteoarthritis that researchers still do not completely understand.

Why Joint Replacement Is Important for Those Who Need It

Pain from osteoarthritis can be crippling and removing that pain generator can greatly improve the quality of one’s life. In patients with advanced osteoarthritis, joint replacement surgery is one of the most reliable ways to remove the pain generator. Without the pain and stiffness from arthritis, people  are able to walk better and do the things they were not able to do before. This could help them become more active, so they can lose weight and have healthier joints and a longer, happier life.

Knowing When It’s Time to See an Orthopaedic Provider

Patients are welcome to see me or any of my colleagues any time if their knees and hips are bothering them. After the evaluation, most patients will not be immediately scheduled for a joint replacement.

First, we try non-operative treatments as they are indicated. These may include over-the-counter pain relievers. We may also try topical anti-inflammatories, bracing, steroid injections and gel injections (viscosupplementation). These treatments can be helpful for some patients. Patients should try all of these first before they consider getting a joint replacement.

A patient is ready for a joint replacement when they have pain every day that limits their ability to do their regular activities, and these other non-operative treatments are no longer effective.

Life Expectancy of a Joint Replacement

The materials used in joint replacements have improved significantly over the years. Generally, a patient can expect a hip or knee replacement to last for 20 to 30 years. Although there are multiple reasons why a joint replacement may fail at an earlier rate, this is relatively rare. I generally tell patients there is a little less than 1% chance per year a joint replacement will go bad. This means that after 20 years, roughly 80% of patients are still doing well.

Frequency of Check-Ups Following a Joint Replacement

After the initial post-operative period, patients should come in every five to 10 years to get routine X-rays. Sometimes the plastic in the joint could start to wear. If we catch it early enough, it is a really simple surgery with a simple solution; whereas if patients wait until the implants are loose and there is a lot of bone loss, it complicates the reconstruction.

The Joint Replacement Procedure

Medically referred to as total knee arthroplasty or total hip arthroplasty, the joint replacement procedure takes about an hour and a half. Patient-specific factors affect how long the procedure will take. Most patients will spend one night in the hospital. Younger and healthier patients will usually go home the same day. Older patients may require a little longer stay in the hospital.

Risks of Joint Replacements

Multiple risk factors can increase risk of infection during joint replacement.

Obesity is the number one risk factor. Keeping weight down and, in particular, having a body mass index below 40 is critical.

Diabetes is another risk factor. There is something called the hemoglobin A1C. Providers take a three month of the average a patient’s blood glucose levels. This needs to stay below 7.5 because, otherwise, elevated blood sugars increase the risk of infection.

Smoking is the third biggest risk factor in joint replacement. Patients should stop smoking several months prior. WakeMed offers a smoking cessation program to make support patients who are trying to stop smoking.

Beyond these three, all medical conditions need to be well controlled prior to surgery, including malnutrition and use of immune modulating drugs that suppress the immune system.

Recovery Time

Full recovery on a joint replacement can take about a year, but most people are happy with their surgery and have less pain after a couple months. Hips replacements tend to recover the fastest. Most patients who have a hip replacement will say they have less pain when waking up from surgery. They may use a walker for a day or two and then go right to a cane. At around the two-week mark, mostly everyone has less pain than before surgery. By six weeks, most hips are not having much pain unless they overdo it. At the six-month mark, most patients are completely pain-free.

Knees are a different story. The first two or three weeks after surgery, the knee is stiff, painful and swollen. Around six weeks, patients often feel a bit better than they did before surgery but still have swelling and stiffness in their knee. Around three months, they are typically happy that they went through with the procedure. Yet, even at three months, patients may have some pain though they should notice there are things they are now able to do that they could not do before. Full recovery is about a year to a year and half and requires a commitment to physical therapy.

Why Choose Wake Orthopaedics

At Wake Orthopaedics, we take great care of patients. Our highest priority is to provide high quality care and provide the perfect patient experience throughout the entire experience.

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About Michael Ruffolo, MD