Joint Replacement: Risks vs. Benefits

How to decide if a hip or knee replacement is right for you.

After a skiing injury 30 years ago, Bert Pepper, MD, got osteoarthritis in his left knee. "I stopped skiing and gave up tennis, running, and other sports that are tough on the knee," he says. "I turned to speed-walking to stay fit, but the knee kept me from walking at a good pace."

As his pain got worse and walking became harder, he looked into having a knee replacement. It's not a decision to make lightly, says Pepper, who is a psychiatrist. "It's a major life event. You have to be prepared to lose a few months to pain after surgery, limited mobility, and vigorous rehabilitation." And like any surgery, it's important to weigh the risks and benefits carefully.

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"There are two main reasons to have a joint replacement," says Charles Bush-Joseph, MD, a professor of orthopaedic surgery at Rush University Medical Center. "The best reason is pain relief."

During a hip or knee replacement, a surgeon removes the painful, damaged surfaces of the joint and replaces them with plastic or metal implants. This gets rid of the pain, because the diseased cartilage and bone are no longer there.

The second reason is to improve joint function, Bush-Joseph says, but these results are less predictable. After a joint replacement, many people can walk more easily. Some may be able to ride a bike or play golf. But there are no guarantees.

Joint replacements carry the same risks as other major surgeries. This includes the risk of dangerous infections or blood clots. People with heart conditions, poorly controlled diabetes, or weak immune systems are the most vulnerable. Surgeons use antibiotics and blood thinners to try to prevent some complications.

The other major risk is that the new joint may not work as well as hoped. Weakness and stiffness are common problems, particularly in the knee. "Patients who don't actively rehabilitate will not regain the maximum range of motion," Bush-Joseph tells WebMD. For best results, knee surgery patients should stick to their rehab schedule of exercise, rest, and medicines.

Less common problems include an implant that becomes loose or dislocates. And it's important to know the implant could wear out after about 20 years. That means you may need another joint replacement down the road.

Joint replacement may be the right choice if you're in a lot of pain and other treatments haven't helped enough. But you want to be sure the joint is the true source of pain, says Michaela M. Schneiderbauer, MD, an orthopedic surgeon with the University of Miami Miller School of Medicine. "The source could be something other than the joint itself, even if arthritis is visible on an MRI."

If you actually have nerve or muscle pain, a joint replacement won't help, Schneiderbauer says. Your doctor can tell the difference by doing a careful physical exam and by asking you questions about your pain. "Be cautious if a doctor tells you you need a hip or knee replacement without doing a physical exam," she adds.

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