Is Joint Replacement Surgery a Silver Bullet?

It is said that some 50 million Americans suffer from the pain and disability caused by arthritic joint pain resulting from joint disease, infection, genetics, defect, injury, or overuse. The nonsurgical treatments, including injections (hydrocortisone, synthetic cartilage, etc.), including draining the inflamed and swollen joint, various braces and supports, analgesics, attempted weight loss, exercise, and stretching, followed by application of a frozen bag of vegetables, are not enough for many of us to provide adequate relief. According to the American College of Rheumatology, the evidence of that is that there are 790,000 knee and 450,000 hip total joint replacements performed each year in the United States.

Despite continuing advances in joint replacement surgery for knees and hips (e.g., the development of the anterior, or frontal, approach which involves less cutting of muscle and reportedly fewer post-operative dislocations), these are major procedures (see my article A Turnabout Well Earned.. In fact, my own personal experience with three marital joint surgeries (and counting) brought to mind Churchill’s famous 1940 speech to the House of Commons, “having nothing to offer [the British nation] but blood, toil, sweat and tears” in the face of the Nazi onslaught.

Surgical joint replacement easily checks off the “blood” part—use of a #10 scalpel blade to make an 8-inch incision enabling internal joint dissection and use various other implements to cut bone, ligaments, and cartilage as needed. Despite the generous use of antibiotics pre- and post-surgery, incision infections do happen and can threaten the new joint. One must continue doses of antibiotics in advance of dental procedures (even routine cleanings) for at least two years—some health practitioners would say for life!

The replacement joints themselves don’t last forever—I was told to expect 10-15 years of use, and I should not run or jump. And they can be dislodged by a fall.

“Toil, sweat, and tears” are provided pre- and post-operatively in abundance. My journey to knee joint replacement started with an ugly torn quadriceps tendon in 2010. With that injury, I wore a heavy brace throughout 6 months of PT (physical therapy). During the first 6 weeks, I could do nothing while the internal repair healed—then PT included a day of three every week when the therapist broke adhesions that had formed in that interregnum.

Post-knee replacement surgery featured PT focused on restoring range of motion, strength, and balance. Sessions were three times a week and involved heel slides, the bike to encourage knee flexion, steps up and down, backward and forward, leg press, abduction, and adduction, and the best part—aggressive, uncomfortable—all right, they hurt—stretching manipulations (a polite term for forcing the knee joint to bend further than it was willing). Progress or not with range of motion (the goal was 125 degrees of knee flexion) was measured with a curious device—the goniometer. My post-hip replacement experience was much easier—a frequent report of others who have had the surgery using the anterior (front) approach. No one could explain why hip joint surgery was generally less painful except that knee joint surgery involves more parts.

My knee and hip results a year and a half out are very good—the same for my wife’s knee joint replacement. The key components for us both include two excellent, experienced surgeons, adherence to post-op PT, virtually no pain meds after a couple of days postoperative, and Aleve before my daily 3-and-a-half mile walk. I am not in the “never again” camp when asked about my two surgeries. In fact, I have scheduled my left hip for a replacement—by the same surgeon who did my right hip. My left hip is bone on bone (no cartilage) and is talking to me—unkindly.

Were the surgeries our silver bullet? They were not easy, lots of pain that gradually improved before going away. And, I had one Rocky Balboa moment (remember those 72 steps at the Philadelphia Museum of Art?)—and I had to work for it just like Rocky did but on a different set of steps. My six months of rehab for my torn quadriceps tendon ended with a scary test. I had suffered my injury, falling and force-flexing my leg, and ended up in Bellevue Hospital in NYC.

So, my final exam at the University of Connecticut Medical School Rehab Facility was to walk down the middle of two consecutive 20-step sets of steps—no brace, no holding on, and being permitted to have only one foot on any step at a time without stopping. I was essentially re-living my denouement at the fancy men’s store in NYC. My therapist, who told me the first day that he had never had a case involving a torn quad before, was waiting at the end. We hugged—and we both had tears in our eyes. He has gone on to become an orthopedic surgeon—I like to think that my right knee played a small role in his career.

Were our marital joint replacement surgeries silver bullets for us, where other non-surgical steps were only temporary fixes? I wouldn’t put it that way. Joint replacement surgery was painful and entailed hard work for us both. Our joint replacement surgeries offered us blood, toil, sweat, and tears, but they were the answer to our unrelieved arthritic joint pain.