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.

An Exercise Fix for Knee Osteoarthritis

Jerry Wade used to love bird-watching with his wife, an avid birder. "I'm not a birder myself, but I like being active and getting out there with her," he says. "Bird-watching puts you into natural areas and some rough terrain -- it's not an easy physical activity." But in the fall of 2005, the 66-year-old Columbia, Mo., resident, who had retired in 2000 from a career in community development, started noticing "pains and twinges" in his knees. A visit to his doctor in January 2006 brought...

Read the An Exercise Fix for Knee Osteoarthritis article > >

"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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Cholesterol Drugs Linked to Muscle, Joint Problems: Study

But heart benefits of statins outweigh risks, expert says

By Steven Reinberg

HealthDay Reporter

MONDAY, June 3 (HealthDay News) -- People taking statin drugs to lower their cholesterol may slightly increase their risk for muscle and joint diseases as well as strains and sprains, a new study suggests.

Statins, such as Zocor and Lipitor, are widely used to reduce cholesterol levels and help prevent heart disease. But they're also thought to contribute to muscle weakness, muscle cramps and tendon problems.

This new study, based on nearly 14,000 U.S. active-duty soldiers and veterans, confirmed an association between the drugs' use and musculoskeletal injuries and diseases. But the findings need to be replicated in other types of studies and should not deter people at risk of heart disease from taking the medications, said lead researcher Dr. Ishak Mansi, from the VA North Texas Health Care System in Dallas.

"Do not stop taking statins; these medications have been life-savers for some patients," Mansi said. "But talk to your doctor about the benefit-risk ratio for you."

Whether statins should be prescribed universally in people without risk factors for heart disease, as some in the health care field suggest, is another matter, Mansi said.

"The side effects of statins are not totally known yet," Mansi said. "Advocating widespread use, specifically for primary prevention in otherwise healthy subjects, is unsound."

The researchers matched nearly 7,000 statin users with a similar number of nonusers to assess the risk of musculoskeletal problems associated with statin use. The results were published online June 3 in the journal JAMA Internal Medicine.

They found that people taking statins had a 19 percent greater risk of having musculoskeletal problems compared with nonusers. Specifically, statin users were 13 percent more likely to suffer dislocations, strains or sprains. They were only 0.7 percent more likely to develop osteoarthritis or other joint problems, which was not considered statistically significant, the researchers found.

The greater likelihood of strains, sprains and dislocations with statin use has not been previously reported, the researchers said. The findings might have implications for physically active people, such as members of the military.

Dr. Gregg Fonarow, spokesman for the American Heart Association, said statin users should be reassured by the findings.

"This study provides further evidence that the proven cardiovascular benefits outweigh any potential risks, including musculoskeletal issues," said Fonarow, a professor of cardiology at the University of California, Los Angeles.

"Statins have been demonstrated in multiple large-scale, prospective, randomized, placebo-controlled trials to reduce the risk of ... cardiovascular events in men and women with or at risk for cardiovascular disease," he said. "In these gold-standard clinical trials there has been no increased risk of musculoskeletal disease."

In the current study, three-quarters of the participants were taking simvastatin (brand name Zocor) and about 20 percent were taking atorvastatin (Lipitor). Smaller numbers were prescribed pravastatin (Pravachol), rosuvastatin (Crestor), fluvastatin (Lescol) or lovastatin (Mevacor).

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Joint Replacement May Reinvigorate Sex Life

Study shows unsung benefit of the surgery may be the ability to enjoy all aspects of life more

By Barbara Bronson Gray

HealthDay Reporter

TUESDAY, March 19 (HealthDay News) -- Although most people get a total hip or knee replacement to decrease pain and move around more easily, a team of orthopedic surgeons has discovered an unexpected benefit: people enjoy sex more after surgery.

A new study found that total hip or total knee replacement surgery improved self-reported sexual function in 90 percent of patients.

Study author Dr. Jose Rodriguez, director of the Center for Joint Preservation and Reconstruction at Lenox Hill Hospital in New York City, created a survey to learn more about how sexual experience was affected by getting a new joint. He said he thought that if he brought up the topic by asking questions about sexuality, people would respond. And they did. "Most patients won't bring up the topic on their own," he said.

Rodriguez said that many patients fear they'll damage the new joint if they have sex, but don't ask any questions about it. Now he makes a point of telling people, after their operations, that "most of what you want to do -- physical and intimate -- you can do."

Getting total hip or knee replacement may improve overall well-being and self-esteem, which itself can be a turn-on, said Rodriguez. "Anything that causes pain and affects how you move is going to influence sexuality," he explained. After surgery, if you feel you are more sensual yourself, you're going to enjoy having sex, he added.

The study, which is scheduled to be presented Tuesday at the American Academy of Orthopaedic Surgeons annual meeting in Chicago, involved reports about sexual activity done before and after total hip or knee replacement surgery. Male and female patients under 70 years old were recruited from the practices of two arthroplasty surgeons. They were asked to anonymously complete and mail back one survey before surgery and two other surveys at six months and one year after surgery.

Out of 147 people who returned the preoperative questionnaire, 116 returned the six-month survey and 65 also sent back the one-year survey. The mean age of patients was about 58 years; there were 69 males and 78 females in the initial group.

Before surgery, 67 percent of respondents reported having physical problems with sexual activity that included pain and stiffness; reduced sex drive (49 percent); an inability to attain the necessary position (14 percent); and psychological issues such as a lack of well-being (91 percent) and low self-image (53 percent).

After surgery, 42 percent of the patients reported an improvement in interest in sex; 35 percent said they had increased duration of intercourse; 41 percent reported more frequent sex; 84 percent said they had improved well-being; and 55 percent reported having an improved self-image.

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