Who Benefits from a Total Hip or Knee Replacement?

By Mark W. Gesell, MD, FACS


Osteoarthritis is the most common form of arthritis affecting more than 25 million people. It is genetic and causes pain, stiffness and destruction within the joint. Common sites of osteoarthritis include the hip, knee, fingers and shoulders. Some patients develop post-traumatic arthritis, which is arthritis that develops months or years after a major injury or fracture in or around a joint. Other forms of arthritis include rheumatoid arthritis and psoriatc arthritis. These are inflammatory diseases which affect the lining of the joints and often affect multiple joints in the arms and legs.

OA symptoms can be managed by anti-inflammatory medicines such as ibuprofen and naproxen. Physical therapy can help maintain flexibility in the joint, and can strengthen the muscles around the arthritic joint.  At it's most advanced stages, OA causes severe pain and stiffness. Once the pain interferes with your daily activities and is no longer responding to conservative treatment, surgery is the treatment of choice.

Total hip replacement (THR) is a very common procedure. More than 300,000 THRs are done every year and this number will almost double over the next two decades.

THR involves removing the diseased, arthritic joint and replacing it with metal and plastic. Newer designs on the market today allow for minimally invasive approaches to minimize blood loss, and help speed recovery.

A recent patient was suffering from OA for several years.  She underwent a successful THR in May 2012. She was in the hospital for three days. She began physical therapy immediately and was walking one day after surgery.  She was discharged home and had a visiting nurse and home physical therapy for two weeks until she was able to attend outpatient physical therapy. Seven weeks after surgery, this patient has no pain in her hip, much better flexibility and has just returned from a trip to Paris. A successful THR has restored her quality of life.

Total knee replacements are one of the most common procedures done. There are approximately 500,000 per year done, and this is expected to increase 3.5 million per year by 2030! More and more patients are participating in a more active lifestyle. Unfortunately, this leads to more injuries, and can lead to a higher incidence of knee osteoarthritis.

Knee osteoarthritis causes pain and stiffness in the joint. The pain is usually along the medial, or inside part of the knee, and is often associated with a slight bowleg deformity. Patients with pain on the lateral (outside) aspect of the knee are less common. Although these patients often have less pain, they may still have difficulty walking due to their progressive knocked-knee deformity. The pain is often a dull ache that radiates down the tibia (shin bone). It is often worse with weight bearing activities, such as prolonged walking, running, and stairs.

Patients with early arthritis often benefit from anti-inflammatory medicines such as ibuprofen and naproxen. Physical therapy is important as it helps strengthen the quadriceps and hamstring muscles and absorb some of the force across the knee. Knee braces are also often helpful, as they provide support for the arthritic knee. Arthroscopic surgery can sometimes be of benefit if the arthritis is minor, and the patient has locking or catching symptoms in the knee.

Once the arthritis becomes more advanced, a cortisone or visco-supplementation injection can be helpful. A cortisone injection helps decrease the inflammation in the joint.  A visco-supplementation injection, such as synvisc or eufflexxa, provides extra lubrication in the joint. Both injections do not reverse the arthritis, but commonly provide some relief from the pain.

If anti-inflammatory medicines, physical therapy, bracing, and injections do not relieve the knee symptoms, it is time to consider a knee replacement. Some patients with localized arthritis in one area of the knee are candidates for a partial knee replacement. These replacements provide good pain relief, and give a more normal feeling knee. Patients can expect a shorter recovery and almost no limitations after a full recovery.

If the arthritis affects the entire knee joint, then a total knee replacement is done. This involves removing the arthritic knee joint and replacing it with a metal implant. A plastic liner fits in between. Patients can expect a 3-4 day hospital stay, and they can start walking with assistance the day after surgery.  Full recovery from a knee replacement takes about 3 months. Physical therapy after surgery is important to help regain range of motion and strengthen the leg.

Newer total knee designs are proving to be more durable and last longer than ever before. Some knee implants have been shown in the laboratory to last more than 30 years of simulated use!