Knowing Your Options: Is a Joint Replacement Right for You?
Melanie Cole: Welcome to Checkup Chat with EvergreenHealth. I'm Melanie Cole and today we're discussing joint replacement. Joining me is Dr. Adam Rothenberg. He's an Orthopedic Surgeon and an Orthopedics and Sports Medicine Physician, EvergreenHealth Orthopedic and Sports Care. Dr. Rothenberg, it's a pleasure to have you join us. Something that's so many millions are suffering from joint pain. What types of conditions cause a joint to break down?
Dr. Rothenberg: Well, we know most commonly osteoarthritis is the most common diagnosis that causes a joint to break down additional diseases that cause that would be rheumatoid arthritis, Inflammatory arthritis, such as a patient who has a history of gout or pseudo gout are also issues. There are other less common inflammatory arthritis diseases, but they all have a similar pathway in that they degrade the cartilage and the structures around the knee that lubricate the knee and provide the normal resilience that we all experienced when we grew up with knee function. If there's an inflammation pathway that causes the cartilage to degrade and then you're stuck talking to me about knee replacement.
Host: Well certainly something that not everyone wants to do right away. So let's talk about the first line of defense. People are weekend warriors, they're athletes, they're grandparents, whatever they are, they start to feel pain in their knees. What's the first thing if they come to you with pain that you prescribe, whether it's physical therapy or medications, what do you do first?
Dr. Rothenberg: That's a good question cause we certainly want to avoid unnecessary procedures and make sure that conservative management is optimized. In my patients, usually they've already started doing this themselves, but we want to minimize aggravating activities. So sometimes they may be doing repetitive pounding or mechanical type of exercises or activities that really put a strain on their hips or knees. And so we try to remove some of the stressors and try to lower the impact, such as using things like cycling or swimming or using an elliptical where there's not continuous pressure and rather there's more control to what they're doing. We also encourage patients to seek out weight loss options and maximize their nutrition. Because what we know from joint health is that if we're at a healthy weight and if we're eating a healthy diet, that our body can usually help calm down any pain and inflammation unless there's something pathologic that you really need to see the doctor for.
Host: Okay, so once it gets past that point and you've tried all of these options that you've just discussed, when does surgery for the replacement become the discussion? What does that discussion look like and tell us about the different types replacements you can perform?
Dr. Rothenberg: Those are definitely good questions. There's an intervening step where the weight loss and activity modifications may not be enough, and between that and the decision for surgery, we're usually going to prescribe physical therapy regimen, either home or supervised by a physical therapist. We're going to try to use anti-inflammatories to try to tailor them for pain relief and to allow you to function better, and then we may or may not prescribe or use injections within the hip joint. It depends on each patient and their circumstance. Then when it comes to surgery, if we've really gotten through this treatment algorithm and you're having significant dysfunction and pain, we're going to individualize your treatment. And there are a number of, for both knee and hip replacements, a number of options that can be tailored to your anatomy and to preserving the structures in and around your hip or knee that are functioning properly and just replacing the parts that are damaged.
Host: So tell us a little bit about what it's like for the patient and how that care, you mentioned personalized, how that care can be personalized for them. It's not just a one size fits all knee replacement, right?
Dr. Rothenberg: Correct. We've come a long way with implant design and how we do the procedures to personalize the care and where that starts, not only in making the decision to proceed with surgery and kind of setting goals with the patients about what they want out of their knee or hip replacement. For example, do you want to go for a weekend hikes? Are you a fitness champion? You want to get back to your triathlon? You know, are you just trying to spend time with their grandkids and get around more lower impact activity level and those feed into a combination of your anatomy, your bone health, your joint health and your goals to then decide what implant is the best match for you and then there are options to use. Advanced imaging such as an MRI or a CT scan to develop a surgical plan that's individualized. That uses custom tools to put in the implants or even sometimes custom implants so that it's matched perfectly just like you wouldn't want to pick the wrong size shoe or a left shoe on your right foot. We want to make sure we get the right implant for you to maximize your function.
Host: Does age play a factor in replacement?
Dr. Rothenberg: It absolutely does. You really ideally need to be at least a certain age to be a candidate for hip or knee replacement. Although we do patients for certain reasons and the young age, if there's no other options. We certainly want patients to be in their fifties or older to get the most longevity out of the implant. The most common age is 65 for patients who have hip, knee replacements. And then when we're individualizing care, if we know that osteoporosis is associated with older age, so in that situation we may be using an implant that doesn't require the body to heal to the implant such as one that requires cement or a glue to kind of glue the implant to the bone. And so that we don't risk problems with putting the implant in with the osteoporosis.
Host: So what's it like as far as recovery and getting back to activities and also Dr. Rothenberg, tell us how pain is managed post-surgery because people have concerns about that now, as well they should
Dr. Rothenberg: Just like the decision for surgery and what we're going to do is individualized. The recovery process can be fairly individual as well. It depends on the kind of level of pain that you've had before and what medications you've been having before the surgery. But we've made great strides in trying to do what's called a multimodal pain regimen. We treat different types of pain at low doses across the board, so we decrease inflammation, nerve pain, and we also try to minimize narcotic usage, but it does have a role in postoperative pain care. We also work with our anesthesiologists to provide numbing type, neuraxial is what it's called, anesthesia of the back or the leg area so that patients can have relief from pain and still have function. The process for recovery, again is variable, depends on each patient's abilities and their pain tolerance, but in general the process for hip or knee replacement takes about six weeks for about 75 to 80% recovery and then ongoing from there on three months to a year for full benefit.
Host: Isn't that amazing what you can do now, so give your best advice for keeping healthy joints, healthy knees, things that we can do that might keep us from seeing you in the first place.
Dr. Rothenberg: I love taking care of patients when they need me, but I definitely want to keep them out of the office if we can. And for keeping a healthy knee, a healthy joint or a hip, you really want to stay active on it. We want to use it. We want to keep hip and motion a knee and motion. We want to be at a healthy weight so that just like everything else in our life, we need to be mindful about what we put in our bodies and staying active is helped by being at a healthy weight. We also want to eat a healthy balanced diet. So some of the really fundamental things that all of our doctors and healthcare providers say to us is true, especially in preventing arthritis of the joints and disability that requires something as dramatic as replacing your cartilage with metal.
Host: Thank you so much Dr. Rothenberg for joining us today and really giving good advice and keeping healthy joints, but if we have to have a replacement, really what's involved. If pain is holding you back from your daily activities, it may be time to talk to your doctor about a joint replacement. To learn more or make an appointment, please visit evergreenhealth.com/ortho-sports-medicine. And that concludes this episode of Checkup Chat with EvergreenHealth. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. I'm Melanie Cole.