Replacement Parts: How to Know When It’s Time

Look out the window. If it’s not raining—or even if it is—you’ll probably see a dog walker, a jogger, or a neighbor working in the garden. We hike, ski, swim, run, play basketball, or push grandchildren in strollers, and it’s all very Northwest. In the gym or the mountains, we like to be active, and we want to stay that way.

Active lifestyles keep us healthy, but with age, we’re more at risk for osteoarthritis. That’s when the cartilage that cushions the ends of the bones in our joints deteriorates. Injuries, weight gain, repetitive stress motion, genetics, or malformations in our joints increase our risk. For some unclear reason, women are somewhat more at risk than men.

As the cartilage continues to wear down, it becomes rough, and there’s more friction when the joint moves. Eventually, you can be left with bone rubbing on bone.

Nancy Branom, a teacher, has a congenital problem with her hip joints. She had no problem as a college athlete, participating in baseball, swimming, and the high jump. As an adult, she and her husband are avid walkers and have traveled extensively, keeping very active and fit. Then, as Branom approached 60, she began to experience “a hiccup in the giddy-up.” There was very little pain, but her leg felt “frozen,” making walking difficult and climbing stairs even worse. Physical therapy didn’t help, and together, she and her surgeon decided on a hip replacement.

Six weeks after surgery, Branom was walking again with no pain. That was three years ago, and this summer, she’ll have the other hip replaced. She’s looking forward to it.

In the meantime, Branom developed arthritis in her right shoulder. The pain was a daily reality, and five months ago, she had a shoulder replacement. “I want to be able to garden, lift weights, and do yoga,” she says. She’s had physical therapy twice a week since the surgery, and while her shoulder is feeling better, it’s not healing as quickly as her hip did.

Branom doesn’t expect her shoulder to be the same as before arthritis. “Maybe I won’t do the same yoga moves or bike as much, or even stretch as much,” she says. On the other hand, she can still walk well without pain, and anticipates no similar problems with her second hip surgery.

When joint pain becomes debilitating, it’s comforting to know that there are options. Surgeons can replace your knee, hip, shoulder, ankle, wrist, or elbow. Knee replacement is the most common; about twice as many Americans are living with knee replacements than hip replacements, the next most popular joint surgery. In the United States alone, there are over 600,000 knee replacement surgeries every year. The majority of patients do very well, regaining mobility and no longer suffering pain. However, surgery should never be the first step to relieve knee pain (or any other joint pain).

Dr. Seth Leopold is an orthopaedic surgeon and a professor of orthopaedics and sports medicine at UW Medicine, as well as editor-in-chief of Clinical Orthopaedics and Related Research. (Orthopaedics is the spelling used at the UW.) He says a good physician should first look for nonsurgical approaches such as losing weight, modifying activities, using a knee brace, or walking with a cane. Physical therapy or injections in the knee may also help. If you’ve tried these options and pain is still limiting your quality of life, your doctor might ask if you’d like to consider knee replacement.

Then there’s this: Results differ, and not all surgical patients get back to their former activities. Leopold says that about one in five may still have residual pain and functional limitations a year after surgery. Also, knee replacements last about 15 to 20 years, so depending on your age, there might be a second surgery in the future.

Sallie Neillie, a health care professional, was a gymnast in college and a runner for 18 years. Besides the health benefits of fitness, she met her future wife when they became running buddies. Eventually, a college injury to her ACL and a later injury to her meniscus forced her to stop running.

Rather than surgery, Neillie chose to stick with other treatment. Physical therapy helps strengthen her muscles to support her knee. She is diligent about her PT, saying that, “you have to be disciplined and do your part.” She’s been able to replace running with walking, and she uses an elliptical machine five days a week. “It’s all about not pounding,” she says. Neillie adds that, someday, she may decide to have her knee replaced, but for as long as she can, she’ll keep it under control with exercise and PT.

If you decide that surgery is the right plan for you, Leopold advises that you choose a surgeon who combines a high level of surgical skill with a high regard for your well-being. Ask questions: What is the doctor’s experience with the procedure? Has she done a fellowship in replacement surgery? Is her practice limited to joint replacements? Be sure you feel a connection to your surgeon, too, because an empathetic doctor will make everything easier.

Priscilla Charlie Hinckley has been a writer and producer in Seattle television and video for 35 years, with a primary interest in stories covering health and medicine, women’s and children’s issues, social justice, and education. She enjoys taking a light-hearted approach to serious topics.