Dealing with Arthritis: Do You Need Joint Replacement

Saturday, May 26, 2012

GoLocalWorcester Health Team

Nearly one third of all Americans over the age of 65 have some form of arthritis. Osteoarthritis (the most common form of the disease) is also one of the main reasons why many patients seek total joint replacement surgery. In fact, the number of Baby Boomers (particularly women) who are seeking this surgery continues to grow with their desire to lead and active (and pain-free) lives.

Approximately 1/3 of replacements are done in individuals between the ages of 45-63, and 4.5 million Americans currently live with total knee replacement in at least one knee. GoLocalWorcester spoke with two local doctors about this pervasive disease and when someone should consider surgery.

Who suffers the most from arthritis?

Ellen Gravellese, MD, chief of rheumatology, UMass Memorial Medical Center: Arthritis takes many forms and can affect people of all ages, including children.

Rheumatoid arthritis is an inflammatory arthritis in which the primary pathology is inflammation of the synovial tissue lining the joint, which induces cartilage and bone destruction. Osteoarthritis is a disease in which the cartilage surface is damaged and/or lost. This can be a result of an injury to the joint, malalignment of the joint, “wear and tear”, or other causes.

It can also be associated with some synovial inflammation but this is not thought to be the primary lesion. OA can affect people of any age including young adults, but it is most commonly seen in the older/elderly population after prolonged use of joints.

As for osteoarthritis, what is the course of therapy? And at what point is a joint replacement necessary?

David C. Ayers, MD, Orthopedist-in-Chief at UMass Memorial Health Care: The course of therapy varies tremendously from patient to patient and is dependent on the aggressiveness of the arthritic condition. When medical therapy no longer relieves the pain and the patient is not able to carry out typical activities of daily living or recreational activities it is time to consider joint replacement surgery

What are the risks of joint replacement?

Ayers: There are several risks of joint replacement; perhaps two of the more common issues are deep venous thrombosis (DVT) or blood clots in the veins of the legs and infection. Blood thinning medicine is given to all patients undergoing joint replacement surgery as are antibiotics.

How does a person decide when it's time to take surgical versus therapeutic action for osteoarthritis?

Ayers: A patient decides that it is time to consult an orthopedic surgeon that specializes in joint replacement when medications and injections are no longer effective in relieving the pain of arthritis and the patient wants to return to a higher level of function in their daily life. The UMASS joint replacement center is one of the leading institutions in the USA in investigating when is the right time to undergo THR or TKR and uses formal computer programs to assist patients make this important decision by utilizing state of the art data on patient pain and function.

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