Sometimes Joint Replacement is the Best Option

With the recent diagnosis of severe osteoarthritis in my right knee, I’m deploying regular Pilates practice, keeping my weight down and reducing inflammation as among the “levers” that I can pull to extract every last bit of mileage out of the original equipment. I hope to postpone replacing this knee for as long as possible.

Knee replacement outcomes have improved over the past 10+ years

Surgeries of all types are invasive. At minimum, recovering from anesthesia, particularly general anesthesia, often takes longer than expected. And then there’s the recovery from the surgery, itself, which depending on the location and type, can take weeks to months. I consider surgery a last-resort treatment for the vast majority of conditions. That being said, I will have my R-knee replaced at the appropriate time.

The “appropriate time” varies from person to person. In my studio teaching, clients often ask my opinion about whether or not to pursue joint replacement. While there’s no objectively “right” answer that I’m aware of, I generally ask clients two questions regarding their body and related pain;

1. Does the joint pain limit your level of physical activity?

2. Does the pain interfere with your sleep?

   
   

If the answer is yes to either one, I generally favor pursuing joint replacement.

Physical Activity

It’s well documented that physical activity is an essential component of good health. Put simply - physical activity extends healthspan, while lack of physical activity is associated with all manner of poor health. Move it or lose it.

Unfortunately, joint pain often deters people from exercising. Perhaps even more insidiously, the decrease in physical activity associated with pain often occurs over many years, such that someone may not even realize they are sedentary. One client in particular, I’ll call them Mike, demonstrated this mismatch.

Mike came to me with the stated goal of avoiding a hip replacement. As we discussed their situation, including viewing their X-rays, I was of the opinion that a hip replacement was inevitable. I offered them all I could with strengthening and stretching exercises, though I also advocated that they consider hip arthroplasty sooner than later. Mike did not agree, and went to another studio that promised that their special technique would eliminate their pain. A few weeks later Mike contacted me to let me know that the special technique was working, and that my services were no longer wanted or needed.

A few years later, I was surprised to receive an email from Mike. They let me know that the special technique offered by the other studio was more or less based on reducing physical activity. As little activity devolved into complete inactivity, Mike realized that the hip needed to be replaced. They had the hip replacement surgery, and Mike faced a l-o-n-g road to recovery, largely due to the period of inactivity that preceded the hip replacement surgery.

While hope may spring eternal, I am not aware of a special technique or therapy that magically regrows cartilage and dissolves bone spurs. At a certain point, most worn out joints become sufficiently painful that even the most disciplined exerciser becomes less active. When joint pain leads to a sedentary life, I believe it’s time to have the joint replacement surgery. Inactivity generally has far worse health consequences than any of the risks associated with hip or knee replacement surgery.

Sleep

Like physical activity, sleep is fundamental for good health. With rare exception, most adults flourish with 7-9 hours of sleep per night. People who get less than 7-9 hours of sleep per night have far worse health outcomes than people who do, including increased incidence of age-related cognitive decline, heart disease and cancer. Sleep is fundamental for good health.

Of the many detriments to health that are associated with aging, poorer sleep is among the most consequential. Whether related to urinary tract health, stress or pain, anything that interferes with sleep can impair optimal health. While some of these conditions may not be treatable, in the case of arthritic knees and hips, sleep can often be improved by addressing the source of the pain. In many cases, joint replacement offers a pathway to reduced pain, and an accompanying improvement in sleep duration and quality. Any of the risks of hip or knee replacement surgery seem minor in comparison to the negative health consequences associated with sleeping poorly.

Joint Replacement

Joint replacement is a major and invasive surgery that I do not wish on anyone. Having worked with dozens of clients both before and after joint replacement surgery, I have come to appreciate how major these surgeries are. Yes, some people bounce back (more accurately, bounce forward) almost immediately after surgery, though I find the majority of people’s lives are significantly impacted for weeks or even months after a joint replacement surgery. These are not minor procedures. At the same time, hip and knee replacement surgeries have come a long way in the past decade or so, and their outcomes are now nearly always positive. While the negative outcomes often get more airtime (negativity bias), both knee and hip replacement surgeries work very well for most of the people, most of the time.

I hope to avoid knee replacement for as long as possible, though I deeply appreciate that this surgical option exists. I’ve seen so many people benefit from joint replacement, and having studied the academic literature, am reassured that positive outcomes are not the exception - they are virtually the rule. If at some point in the future I experience knee pain that keeps me from exercising or sleeping well, I’ll immediately get in my orthopedist’s queue to get the worn out parts replaced!