When is it time for a knee or hip replacement?

Total and partial knee and hip replacements have been a normal surgical intervention for 50 years! People may have a knee or hip replacement due to fractures, birth defects, serious illness, loss of joint movement and pain. But is a joint replacement the right answer all of the time? In short, no! When should you consider invasive surgery?

If you have fracture your hip following a fall (the 2nd most commonly fractured bone in the human body) and it cannot be fixed.

Birth defects for example; Perthes (where the head of the femur [top of your thigh bone] can collapse.

Congenital hip dysplasia (where the hip socket isn't formed correctly)
Serious illness.
Loss of movement. If your knee or hip will not functionally bend from advanced arthritis and your quality of life is severely affected, for example; climbing the stairs.

When should you not consider invasive surgery?

To manage pain

Pain management is not recommended for a joint replacement! There is vasts amounts of supporting evidence based on longitudinal studies and first hand patient encounters that do not advocate the management of knee and hip pain with joint replacement.

There are scores of people who have gone on record following a knee replacement who say: "I wish I had never had it done"! Additionally, a good surgeon will also support this. A consultant said to me once: "I would never do a knee replacement for pain management only".

But my X-ray shows I have arthritis?

Evidence is fast growing that shows what may show on an image may not be why you are having joint pain or lack of movement. As the image below shows, a knee is almost as likely to have arthritic changes (osteophytes) in the absence of pain, as a knee with pain. It therefore stands to reason that what imagery shows us, may not be what is causing the problem. What is becoming more evident is, most joint pain stems from muscle weakness, leading to altered movements and increased load through joints.

What are the alternatives?

If you are suffering knee and or hip pain through arthritis for example and you have functional movement of that joint, then strengthening exercises through physiotherapy to that joint, in addition to a well managed regular pain relief programme has been shown to be far more effective than what a surgeon's knife can offer.

What some people may not appreciate is, once a joint has been replaced, the patient would have to undergo physiotherapy to regain the strength in the associated muscles following the surgery. In addition, it isn't always a guarantee that you will regain more movement in the joint.

For example; some surgeons who have performed a total knee replacement are happy if the knee will bend to 90 degrees. The patient may have had more of a bend in the knee before the surgery, and may have only been limited by pain. It has been well documented in research and best-practice guidelines that strengthening exercises can reduce pain and therefore increase your quality of life. By making the muscles stronger around a joint, they can act like a shock absorber, distributing less weight through the joint and therefore less pain. Pain relief taken regularly has been shown to masque the pain, so people suffering with joint pain can increase their movement, which in turn increases muscle strength. By masquerading pain, does not mean we are masquerading damage. No amount of damage will occur to a joint if we increase our efforts.

In fact, recent research has shown that by doing particularly more can actually have a positive effect on joints and joint related pain. It can no longer be said that running ruins your knees. A recent study has shown that running can actually slow down the effects of arthritis. If you are suffering joint related pain and are concerned that you might need a joint replacement, be sure to contact Mike Stamp Physio & Pilates to discuss your concerns further.