WHEN SOMEONE WITH SEVERE CHRONIC JOINT PAIN is weighing the option of joint-replacement surgery, there are many questions to consider: How can I determine whether surgery is the most appropriate treatment option for me? How will the procedure and subsequent recovery period impact my life and schedule? What degree of pain relief can I expect after recovery?
But perhaps the most important question to ask is, how much will joint-replacement surgery improve my quality of life and my ability to participate in the activities I enjoy? For many joint-replacement patients, that improvement is profound.
Of course, not all patients with joint pain are candidates for replacement surgery. Nor is surgery typically the first-line treatment for a painful joint. According to Mercy Health orthopedic surgeon Bradley Morse, MD, patients complaining of joint pain are evaluated through physical examination and x-rays to determine whether arthritis is the underlying issue, and then they’re treated according to the severity of their condition.
“We usually start with anti-inflammatory medications,” he says, “but if the pain either doesn’t improve or gets worse, we can move on to various injections such as corticosteroids. We can also try viscosupplementation, or so-called gel shots, to help restore lubrication in the joint. Eventually, when the pain no longer responds to conservative measures, we’ll determine whether the patient is ready for replacement.”
Dr. Morse explains that patients with pain and dysfunction who are unable to manage daily activities or are having difficulty with their job performance due to pain are often good candidates for surgical replacement. Those whose painful joint has already progressed in severity to the point of being bone-on-bone are also considered good potential candidates for surgery, as they are unlikely to achieve relief through conservative measures.
Though joint replacements and other elective surgeries were put on hold earlier in the COVID pandemic, they are now being offered again. Dr. Morse notes that the COVID crisis actually led to a positive development in the realm of orthopedic surgery—the availability of outpatient, same-day joint replacement surgery. “When we first started doing joint replacements again after the pandemic, we wanted to reduce the need for hospital stays in order to limit COVID transmission, so we put systems in place to allow us to do some of these procedures on an outpatient basis,” he says. “Currently at Mercy Health – St. Charles Hospital, close to 85% of these patients are going home on the same day.”
As with joint replacements in general, outpatient joint-replacement surgery is not for everybody. For example, an 85-year-old who lives alone in a home with numerous stairs to climb might not be the best candidate. However, with ample preparation and patient/family education prior to surgery—and further facilitated by the at-home nursing and physical therapy services that are now available—many patients can benefit from the convenience of outpatient surgery.
Whether the procedure is done on an inpatient or outpatient basis, it’s important for patients who undergo joint replacement to know what to expect during the recovery period and to have realistic expectations with respect to the outcome. Dr. Morse states, “I tell my knee-replacement patients that in the first few weeks after surgery they’ll be asking themselves, ‘Why the heck did I do this?’ But that will soon change to ‘Why the heck did I wait so long to do this?’”
Dr. Morse adds that most recovering patients do physical therapy at home for the first few weeks but then transition to an outpatient setting. He says that the pain usually improves significantly within six to eight weeks of surgery, though it may not be gone completely. “Patients who do best are the ones who go in with the proper expectations, and that’s where prior education comes in. Our goal is complete pain relief, but not everyone gets to 100 percent. Some may still have a certain degree of pain after surgery, though it should be 80 to 90 percent better, if not 100 percent, and they’ll be able to do a lot more things without restrictions and without that severe, debilitating pain. The most important thing to keep in mind is that every patient is different. Some recover more slowly or more quickly than others. Don’t assume your experience will be the same as your neighbor’s,” he emphasizes.
The best time of year to get a joint replacement surgery varies from patient to patient, but many individuals choose to schedule them late in the year when they’ve already met their annual insurance deductible. In fact, Dr. Morse and his colleagues typically set aside extra surgical time at year’s end to accommodate all the joint replacements that are requested.
So, if you’re coping with chronic joint pain and questioning whether joint replacement might be the right choice for you, there’s no time like the present to see an orthopedic specialist for an evaluation and expert recommendation.
