Dr. Miller: When's the best time to get that hip replacement? We're going to talk about that next on Scope Radio.
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Dr. Miller: Hi, I'm Dr. Tom Miller, and I'm here with Dr. Chris Peters. Chris Peters is a professor of orthopedic surgery here at the University of Utah.
Chris, the old saw was, well, at least when I trained in medical school, if you had to have your hip replaced, or your knee replaced, you ought to wait as long as possible, maybe even until the time that you're crawling, because there was some concern that the surgery was a little risky. That's not the case now is it?
Dr. Peters: No, you're right, Tom. There has been a very profound change over the last, I would probably say the last twenty years. When hip and knee replacement was first begun in the late 1960s and 1970s, those initial cases were done on people who had kind of disastrous arthritis, and they were folks who were predominately wheelchair bound.
Dr. Miller: They were the worst of the worst.
Dr. Peters: Yeah, the worst of the worst. Over time, what we have seen is that there's been a slow, steady change, and a realization that actually waiting is perhaps detrimental to overall patient health in many cases, and so I think now we realize that, for instance, if a patient's in their early 60s and has some health problems, which is common these days, diabetes, high blood pressure, and their functional status is profoundly impaired, that is they can't go out and recreate, they can't go for a walk around the block, they can't go play with the grandkids comfortably, those patients are probably better off treated with surgery earlier, rather than the old conventional wisdom of waiting as long as you possibly can.
Dr. Miller: Well, technology and techniques have improved, I would think, remarkably since the first joint implants had been done, right? So a lot has changed in terms of the functionality of the implants, and the time to recovery, and the physical therapy that's done afterwards so that people can get back to do many of the things that they were doing previously sooner.
Dr. Peters: Absolutely, and again, back in the '70s and even into the early '80s and '90s, we had concerns about implant longevity. We used to tell patients, we hoped this would last, that a hip or a knee replacement would last ten years. And what we found is that the longevity of the current generation of prostheses that we use is probably more likely 15 to 20 years. And so again, that patient who's in their early 60s is likely to see a hip or a knee replacement last the rest of their life, and they're likely to see their functional status be quite good throughout the last several decades of their life.
Dr. Miller: Now is it true the longer one waits, the kind of weaker the ligaments and muscles around that particular joint become? I would think, if that was the case, that rehabbing that area after surgery would be even harder.
Dr. Peters: Right, and what we find is that patients who wait too long come to us in what we call a deconditioned state. So we start to see deterioration in other organs, and often what goes along with that is obesity, weight gain. And many of these things can be reversed. When you restore ambulation, you restore the ability to get out and exercise. So I think patients often today are much better to have an arthritic hip or knee replaced sooner rather than later.
Dr. Miller: So Chris, when will the right time be? I mean, it's individual. Obviously it's an individual decision, but how do you advise patients?
Dr. Peters: The optimum time obviously is individualized for every patient that we see, but if a patient comes to us and they have X-ray or radiographic evidence of arthritis and can describe to us a significant impairment in their life, whether that impairment is the inability to go out and play nine holes of golf after work, or whether that impairment is an inability to go to the zoo with their grandkids on the weekend, and they're experiencing significant pain, and they've gone through a period of time using the standard medications that people use for pain, such as anti-inflammatories, if they've gone through that process and they're in that position, they're probably ready for a joint replacement.
Dr. Miller: Do you ever recommend that they do some of these other treatments such as injections into the joints of lubricants or prednisolone, something to calm the joint down before you make that decision?
Dr. Peters: Sure, there is absolutely a role for what we would call conservative or non-operative therapy. And there's evidence that, for instance in the knee, that corticosteroid injections can provide short term symptomatic relief, and we'll use those fairly commonly in patients in the earlier stages of arthritis. But once you get to significant bone on bone contact, and the whether it's in the hip or the knee, those modalities tend to be just very short term pain relief, really aren't the long term strategy for treating the patient.
Dr. Miller: They just don't last, do they?
Dr. Peters: Right.
Dr. Miller: The primary reason to do a hip replacement, as I understand it, is to reduce pain and to increase function, but it's so much more than that, isn't it Chris?
Dr. Peters: Right, and it's really a fascinating thing. As orthopedic surgeons, we start a little bit with this tunnel vision. You've got a patient comes in with an arthritic hip or knee joint and we get excited about replacing that, because we know that there's a pretty predictable improvement in pain and function when we do a hip or a knee replacement, but what we found over time is that there's incredible added benefits to the patient as well. So their overall health tends to improve.
We see patients who come in to us as a diabetic, and who are significantly overweight, and now they can get back out and exercise, they can get on their bike, they get into a Zumba class, they lose weight. Often they'll go from an insulin dependent diabetic to on to an oral agent controlled diabetic. We see we see significant improvements in overall health just resulting from the ability to be more active after a hip or a knee replacement.
Dr. Miller: So it's so much more than just improving function and decreasing pain.
Dr. Peters: Absolutely, yeah. I mean, I think it's one of those things that joint replacement surgeons didn't appreciate very much until, I would say, the last decade or so, but now we can, I think very reliably, with good literature support, tell patients that not only is their arthritic hip or knee going to feel better, but likely their overall well-being will be better.
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