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Do I need a joint replacement?

This is an increasingly common question being asked by our patients. Why is this? The prevalence of joint replacements in England is increasing all the time (with the exception of a dip during the COVID years) with over 3 million operations being performed each year1. The vast majority of these involve the hip (47%) and knee (50%) with the remaining 3% being split between the shoulder, ankle and elbow. Surgical techniques are improving all the time and the outcome measures are getting better and better2 – particularly as post-op rehabilitation is being prioritised to achieve the best possible outcome. The age profile of people having joint replacements is clearly set out here by NHS England with surgery peaking in the 75-79 age group.

That is not to say joint replacement is the entire preserve of the older adult. My son was diagnosed with a childhood disease affecting the hip (Perthes) which necessitated a full hip replacement at the age of 22! Whatever your age, there are some careful considerations to be made before you take that step towards replacement surgery which I’ve set out below:

Do you have a clear diagnosis?

First things first – a clear diagnosis of joint degeneration needs to be made to warrant you needing a joint replacement in the first place. The terminology here can be confusing. The reason why joints are replaced is because the joint is no longer able to function without pain and stiffness. This is caused by degeneration of the joint surfaces or ‘wear and tear’. The medical diagnosis is osteoarthritis (OA) and this is graded based on the X-ray – usually either mild, moderate or severe.

How severe are the symptoms?

Assuming OA has been diagnosed, the next question is how severe are the symptoms? It is possible, indeed quite common, to have quite severe arthritis noted on X-ray but not have much in the way of pain and stiffness. This is an odd anomaly but a joint replacement won’t be needed if the joint isn’t causing any real problems in the day to day despite having a bad X-ray! We use a range of measures to assess the pain and impact on life (including questionnaires like the Oxford Hip Score). Equally, patients can have quite severe pain without there being very bad OA changes visible on X-ray although this is more unusual. Most people have life altering symptoms (e.g. disturbed sleep, limited mobility, constant pain etc) and most surgeons would advise against surgery if this wasn’t the case.

Will the op definitely get rid of the pain?

This is for the clinicians in charge of your care to determine and is usually done with skilled examination and, on some occasions, further investigations. We’ve noticed a trend recently of orthopaedic surgeons performing injections of local anaesthetic into the joint to confirm that this (temporarily) gets rid of the pain as this provides further confirmation of the diagnosis and reassurance for the surgeon that the surgery will work! It does, however, add to the delay of surgery and potentially introduces an unnecessary and costly procedure.

Are you ready?

So, it’s been decided that you need a joint replacement. The focus now becomes on you, the patient. This is a big decision. The outcome figures from surgery are excellent and getting better all the time but every procedure carries a risk – and complications like dislocation and infection are significant – albeit very rare. My counsel to patients is always to ensure all other avenues have been explored first. You need to go into surgery knowing that this is the best option and other treatments have failed to achieve the improvement needed. That exploration may be relatively short and a decision to proceed with surgery made quickly. For others the process can take longer – sometimes over several years. Your physio, orthopaedic consultant or GP can guide you in this process and in most cases a consensus reached.

Don’t take our word for it

We want you to make the best decision possible so, whilst we rate our professional opinion, we would encourage you to seek the advice of from the clinicians you trust – your physio, GP or orthopaedic consultant etc. There is an old biblical Proverb which is worth applying here:

‘Plans fail for lack of counsel but with many advisers they succeed’. Proverbs 15v22

If you’d like to discuss a joint replacement decision or any other matter, do get in touch – we’d love to hear from you!

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