February 9, 2018

If you have been experiencing chronic pain and loss of mobility in your joints, there is a good chance the possibility of a joint replacement has crossed your mind.  Joint replacement can be a very effective means of treating pain and improving quality of life – but is it the right option for you?

Dr. William T. Jones, of the Orthopaedic and Sports Medicine Center, looks at many parameters before recommending a joint replacement. However, two are particularly important: quality of life issues and the degree of joint damage.

To identify a change in quality of life, Dr. Jones looks at pain and mobility and the ability to perform everyday tasks and activities.

“[Pain and stiffness] can interfere with the ability to get up and down out of chairs, in and out of cars, that sort of thing.”  Dr. Jones said.  “With a hip or knee that is stiff from inflammation, it is difficult to do those things. If you cannot elevate the leg enough to clear steps and door raises, it can increase the risk of falling.”

Quality of life issues also include sleep disturbance, diminishing weight bearing activities, and depression - all potentially triggered by chronic joint pain and diminishing function. Even basic activities of daily living, like house cleaning, grocery shopping and low-impact exercise, become difficult.

Along with a reduction in quality of life, Dr. Jones looks for damage to the joint and the surrounding area in prospective joint replacement patients.  X-rays and MRI provide information concerning the “health” of the joint. 

“Usually when the cartilage on both sides of the joint is either gone or close to gone, i.e. “bone on bone”, in conjunction with those quality of life issues, that is typically when it is worthwhile to discuss a joint replacement,” Dr. Jones said.

According to Dr. Jones, osteoarthritis is a genetic disease, but there are certain lifestyle and health habits that may have a hand in causing the damage. Obesity and smoking are both correlated with arthritis and joint damage.  Repetitive high-impact loading such as running and jumping over a period of many years and specific traumatic events may contribute to cartilage damage.  Since osteoarthritis is a genetic disease, some people may develop arthritis despite having no risk factors. 

“There is an extensive amount of research related to arthritis going on worldwide," Dr. Jones said. "Unfortunately, many questions remain unanswered, such as what specifically triggers osteoarthritis, how the cartilage damage can be reversed, and whether new, functional cartilage can be generated within the joint.” 

There are a number of treatment options for joint pain before turning to replacement.

“If you have pain and stiffness, if you're losing sleep, or having trouble focusing at work, it is worthwhile to come in and have an evaluation.”  Dr. Jones said. 

Basic treatment includes low-impact exercises, weight reduction, smoking cessation, evaluation of bone density, activity modification, simple braces, and good shoes with inserts.  Over-the-counter supplements such as glucosamine, chondroitin, and turmeric, and over-the-counter medications such as Tylenol and low-dose NSAIDs may be helpful.  A number of injections are available, but none significantly alter the natural history of arthritis.

Arthritis damages joint cartilage and subchondral bone, which in turn leads to inflammatory pain, mechanical pain, joint stiffness, and in some situations, joint instability.  Increasing levels of joint damage typically cause increasing symptoms and deterioration of quality of life.

The combination of significant joint damage (confirmed by imaging such as x-ray, CT, and MRI), along with significant quality of life issues, begin the conversation of joint replacement.

If you are experiencing diminishing quality of life as a result of joint pain, click here to schedule a consultation with our doctors. There are many options to improve symptoms - seeing a doctor is an important first step.