Joint replacement surgery: an individualized decision

As a general internist who does primary care for adult and elderly patients, I talk to patients a lot about arthritis and joint replacement surgery. This type of surgery, also known as arthroplasty, is one of the most common types of elective surgery done in the United States. Knees, hips, and shoulders are the most frequently done arthroplasties, and most of those surgeries are done for severe osteoarthritis.

Osteoarthritis, the most common type of arthritis, is due to wear-and-tear of the joint, and becomes very common as we age. It often can cause debilitating pain and difficulty with function which, for some patients, warrants the intervention of surgery.

My patients often want to know when it is the right time for a joint replacement. Well, no x-ray or diagnostic test can tell us that. The decision to go ahead with arthroplasty is very much individualized to the patient. How severe are their symptoms? How risky is surgery for this particular patient? How much quality of life do they stand to gain from a successful arthroplasty?

While the orthopedic surgeon is the expert who patients should trust in talking about the risks and benefits of surgery itself, sometimes as a primary care provider who knows intricately my patient’s medical history, general day-to-day life, and feelings about medical and surgical interventions, I can be helpful in guiding my patients facing this decision. Often I help nudge the reluctant patient who is suffering from severe arthritis toward choosing a surgery very likely to improve their quality of life. Rarely, I might help a patient with less to gain from a surgery reconsider its risk to benefit profile.

A couple years ago I surprised myself by encouraging my patient, then 95, to consider hip replacement surgery. I never thought I would urge a patient in their 90’s to undergo elective surgery, but this particular patient was in excellent health and rendered unable to continue his beloved daily exercise because of his hip arthritis. The inability to exercise, for him, was a major problem for quality of life. He got his hip arthroplasty and enjoyed a couple more active years before his recent death.

So, if you are wondering whether you should go ahead with replacing that bothersome arthritic joint, there is no perfect formula that applies to everyone. But a primary care provider who knows you well can sure assist you in making the best decision for yourself.

Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central.