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When to consider joint replacement surgery


When to consider joint replacement surgery

If you’re struggling with chronic joint pain that’s limiting your daily activities, you may begin to start thinking about joint replacement surgery.
Chronic joint pain is most often caused by osteoarthritis, a progressive condition in which the cartilage on the surface of bones in a joint begin to erode. As osteoarthritis advances, there’s less cartilage to cushion the joint. Without protection, the bones that make up the joint rub together when you move, causing inflammation and pain.
“That can cause significant dysfunction in a person’s day-to-day activities,” says Tidelands Health orthopedic surgeon Dr. Derrek Woodbury. “If a patient is functioning well with conservative, non-operative treatments, it’s not time for replacement surgery. But when patients are continuing to have pain that’s causing significant dysfunction in their life, when they’re having pain every day that’s not improving with medication, physical therapy or activity modification, then we’re starting to move toward total joint replacement as a viable option.”
Before surgery is pursued, patients have several non-surgical treatment options, including:

Weight loss

The least invasive, non-operative treatment that has proven to work at relieving pain is weight loss.
“Patients who are successful with weight-loss management, I may not see them again because often their pain goes away,” Dr. Woodbury says.

Anti-inflammatory medications

Nonsteroidal anti-inflammatory drugs are often used to treat the pain and inflammation associated with arthritis. By reducing joint swelling, these medications can help relieve pain.

Physical therapy

Exercises to strengthen the muscles that support the joint can help relieve joint pain and improve mobility and range of motion.

Activity modification

Patients with pain may find relief by dialing back strenuous or repetitive activities involving the painful joint. Modifying the amount of activity may provide some relief.


Another way to fight inflammation and alleviate pain is with steroid or gel injections in the affected joint. The medications are injected into the joint and can provide six months or more of relief.

Nerve block treatment

Another option your care team may try is a nerve block treatment that targets the nerves that transmit pain signals to the brain. Patients can experience improved mobility and pain relief for up to 12 months.

Topical applications

There are a variety of creams and ointments that can be applied directly to the affected joint, but benefits are generally short lived.

Joint replacement surgery

When all other non-operative methods have been exhausted and patients are still having pain and mobility issues, then joint replacement surgery becomes something to seriously consider, Dr. Woodbury says.
“Patients have an intrinsic ability to know when it’s time,” he says. “They tend to know when the knee or hip is not working anymore. When we’ve tried the conventional treatments and they’re not working, we move toward the operative direction.”

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Some patients fear having surgery because of possible complications, but the risks are low. Delaying the need for surgery can lead to worsening pain, as well as physical and emotional challenges.
“It can cause more problems with maintaining your weight, and any time you’re dealing with pain, it can be really rough psychologically,” Dr. Woodbury says. “It can lead to depression and certainly impact your quality of life.”

What to expect

Some people put off surgery because they’re intimidated by the recovery process, but it’s not as difficult or as long as it was in the past, says Dr. Woodbury, who specializes in knee and hip replacement. After a total joint replacement, patients can expect to make a full recovery within three months, depending on the patient’s health status before the procedure. In the case of knee or hip replacement, the individual may use a walker or cane for assistance for several weeks until he or she is able to walk unassisted.

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“Typically, a patient is going home the same day as surgery or the day after,” Dr. Woodbury says. “They’re putting most or all of their weight on the extremity, they’re working with a physical therapist and they’re receiving pain medication to take the edge off the pain.”
Within a few weeks, the patient typically returns for follow-up X-rays to ensure the joint is properly positioned and working as expected, as well as to verify the wound is healing well.

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Patients with weakness may undergo physical therapy to improve strength and flexibility prior to surgery to improve their outcome post-surgery.
“If you’re not sure whether you need joint replacement surgery, we can offer you an evaluation and thorough exam and give you good information so you can make an informed decision about your care,” Dr. Woodbury says. “And if you need joint replacement surgery, we have a team of excellent surgeons who can provide a full spectrum of care, whether it’s for a knee, hip, shoulder or other weight-bearing joint replacement. We’re here to meet patients where they are and provide them the care they need.”

Dr. Derrek Woodbury is a fellowship-trained orthopedic surgeon who practices at Tidelands Health Orthopedics at Georgetown. He is accepting new patients.

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