July 11, 2023 – Kathy Blackwell is determined not to let her aching joints hinder her from living her best life. Blackwell, a 73-year-old resident of Simi Valley, a community near Los Angeles, organizes regular activities for her group of seniors. Despite having her hip and both knees replaced, with plans for a second hip replacement, she intends to delay surgery and opt for a cortisone shot to manage the pain. Blackwell is an advocate for joint replacement and has undergone multiple procedures. She believes that enduring chronic pain without relief can take a toll on one’s well-being.
Joint replacements, particularly knee and hip replacements, are becoming increasingly common. The American College of Rheumatology reports that there are approximately 790,000 total knee replacements and over 450,000 hip replacements performed each year in the United States. Age is not a determining factor for joint replacement candidates. Surgeons have successfully performed these procedures on patients as young as 12 to as old as 102. The average age for a hip replacement is 66.
Post-surgery therapy and treatment are critical considerations for older patients. Younger patients must also consider the potential need for additional replacements in the future, as joint replacements typically last around 25 years. Complications from these procedures are rare, occurring in only about 2% of cases. Such complications include infection, joint dislocation, and blood clots. Other existing health issues do not generally impact the success of joint replacements.
Blackwell’s experience with her first knee replacement was challenging. Her initial surgeon did a poor job, resulting in a severe wound infection that required multiple surgeries and wound vacuum therapy. She eventually found another surgeon who successfully corrected the problem. Despite this setback, Blackwell underwent a second knee replacement and a hip replacement, both of which were successful. She expressed that her entire attitude toward life has changed since these procedures.
Primary care doctors should ask two primary questions when considering joint replacements for their patients: Have nonsurgical treatments been exhausted, and is the pain intolerable? The use of narcotics to manage symptoms should be avoided. Ultimately, the decision to proceed with surgery depends on the severity of pain and imaging results. Patients who have not responded well to noninvasive treatments may be candidates for joint replacements. However, surgery should not be rushed, and alternatives should be explored, such as modifying activity levels and lifestyle changes. The emotional well-being, pain tolerance, and support system of the patient should also be taken into account, along with their ability to afford time off work for post-operative care.
Older patients tend to respond better to knee replacements than younger patients due to differing expectations. Older individuals may be satisfied with pain relief and improved quality of life, while younger patients may desire a return to high-impact activities. Conservative management options should be considered first, including rehabilitation exercises, braces, medication, and weight loss efforts. Surgery should only be pursued if these measures fail to alleviate pain and improve the patient’s quality of life.
Blackwell’s joint pain is simply a result of a well-lived life, with no significant incidents or extreme physical activities contributing to her condition. Despite the challenges she has faced, her determination to continue enjoying life is unwavering.