In my seminars, I outline active approaches to managing your arthritis in order to help control pain and maintain mobility. One of those active approaches that many patients eventually will need to consider is joint replacement.

  First of all let me emphasize that the single concept underlying all of our efforts at Arthritis Education by Professionals, Inc. is education. From the beginning, I have believed that arthritis patients would do better with joint replacements if they were provided with solid patient education. Over the years, I have held pre-operative educational classes for patients and also have provided custom-made informational videos, booklets, brochures and other educational materials to help answer questions. The patient always plays an active role in the decision-making and ultimate success of the procedure. The philosophy is that a patient is not simply a"hip" or a "knee"--a patient is a whole person who also has other needs in terms of managing arthritis and independence.

Making the Decision

   So, once conservative measures such as medication and activity modification have failed, it's time to consider joint replacement. By this time, patients have what we call end-stage arthritis--a significant loss of cartilage in the joint(s), perhaps bone spurs, and the ligament instability and muscle atrophy that occur when a joint is unable to move and function as it was intended. Often there is pain related to these mechanical changes, and it worsens as you put more weight on the joint. There may be limping, deformity (especially in the knees), loss of joint motion and loss of leg length. In addition, the patient's overall physical and mental health may be negatively affected because it's simply too hard to get up and be active.

  The direct benefits of joint replacement are that it reduces or eliminates pain, restores lost range of motion, and, in the case of hips and knees, improves the gait and corrects deformity. The indirect benefits are just as important: by restoring the ability to walk and function, joint replacement gives you the chance to rebuild your cardiovascular and pulmonary conditioning. Even your mental outlook will bloom, as you are once again able to get around, enjoy life and make a contribution to the world and the lives of others. Joint replacement is like a drop of water in a pond--its beneficial effects spread throughout your body and your life like ripples on the water.

  In making the decision to have a joint replacement, patients often will wait until their lifestyle is simply no longer acceptable and they can't stand the pain any longer. However, there is such a thing as waiting too long. Especially for people with osteoporosis or poor bone material due to rheumatoid arthritis, you may be leaving the surgeon less to work with, which means the joint might not turn out as well.

  It's not that you should be pushed into surgery before you're ready; it's just that you need to weigh the risks vs. benefits early on. That way you actively make the decision when the time is right. You should be in control, rather than making the decision from the standpoint of a victim ("I can't stand this anymore") and having the disease control you. When you're empowered, you will work harder to achieve an excellent outcome.

  Fear often keeps people from making the decision to have surgery, but that's where education comes in. If we can give you the proper information and education, the decision may be easier. And sometimes, after weighing all the options, the decision can still be "no." Perhaps now is not the right time, but joint replacement can be an option for the future.

A Shared Responsibility

   Neither the doctor nor the patient is totally responsible for a successful joint replacement; it is a shared responsibility.

  It's extremely important that you see an orthopaedic specialist who is skilled in joint replacement and has a great deal of experience with the specific procedure you need. After all, if your carburetor needed fixing, you wouldn't take it to a garage that fixed maybe 10 carburetors a year; you'd take it to a carburetor specialist who works on 200 or more carburetors a year. It's the same with your joints. You need to know that the surgeon and his or her team are not only experienced and knowledgeable in joint replacement, but that they are current, up to speed on the latest innovations and able to react quickly to changing circumstances that might occur during surgery.

  The bottom line is that it's important to select a surgeon who has done a large number of joint replacements, one who does research on his own patients to track success rates, and one who will willingly give you data on patient outcomes. A surgeon simply stating that he or she is "experienced" in joint replacement is not enough of a recommendation; be sure to ask for numbers.

  When you see the surgeon in the office, he or she will do a physical examination that includes a complete medical history, x-rays and a visual analysis of your gait. To prepare for surgery, your doctor will handle all the scheduling, and help you arrange for your pre-operative blood work, electrocardiogram (EKG) and chest x-ray. If you prefer, you may also donate some of your own blood (autologous blood donation) in case you need it during the procedure.

What to Expect in the Hospital

   I've outlined the many benefits of joint replacement, so now let's take a look at the risks. Of course there is risk with any major surgery, and joint replacement is no exception. But it has been proven that the patient will do better if we adopt a preventive mentality, instead of waiting until something crops up and treating it.

  In joint replacement there are two kinds of risks: local and systemic. Local risks happen at the joint itself, and the most often discussed of these is infection. But again, prevention is key. For instance, instead of waiting for an infection to develop, we operate in surgical suites equipped with laminar airflow, a "clean room"-type system that eliminates almost all chance of infection. In addition, the surgical staff wears "space suits" with individual air hookups and exhaust systems to prevent the patient from coming into contact with them. We also administer preventive antibiotics to the patient before, during and after your surgery. These precautions pay off for patients by resulting in a much lower infection rate.

  The other type of risk with joint replacement is systemic, changes elsewhere in your body that are caused by the days of relative immobility as you recover from surgery. (These risks could crop up with any major surgery, not just joint replacement.) Because the operation is a major trauma to your body, your systems tend to close down slightly. With the cardiovascular system, the risk would be blood clots. However, we dramatically reduce the chance of blood clots forming through the use of carefully regulated blood-thinning medication. Instead of waiting for pneumonia to develop, we schedule several days of breathing treatments to help clear the lungs after surgery. Your skin may be irritated from the pressure of lying in bed; also, you may develop constipation or a urinary tract infection. The point is, we tell you in advance about these things so that we can all work together to prevent them.

  On average you can expect three to five days of hospitalization, depending on your personal situation. Everyone is different. Some patients may need to stay in the hospital longer than others, such as patients who not only have arthritis but also have cardiac or pulmonary difficulties. It's important to evaluate patients' abilities and disabilities beforehand to be sure they receive all the help they need while in the hospital.

  The day after your surgery, you are going to get out of bed with a physical therapist and start your rehabilitation. No excuses! The physical therapy is mandatory-you're not allowed to pretend you can't get up, or refuse because you didn't have a good night's sleep. You will get up--because activity is what gives you back your life.

  In terms of discharge options, you may be sent home with your family to assist you, or with arrangements for home care; you may be discharged to an extended care nursing center or skilled nursing facility within the hospital; or those who require more intensive rehabilitation work may be discharged directly to a rehabilitation facility. Family support, your physical strength and motivation are all factors to be considered in the discharge.

  Afterward, you'll spend a few weeks on an assistive device such as crutches or a walker. Daily exercises will strengthen your new joint and the muscles that have weakened from non-use. During this time your mobility will be curtailed, but after six weeks you'll visit your surgeon for a checkup and then life will get pretty quickly back to normal. In the long term, you can do just about any activity that has a "gliding motion," as opposed to a "direct impact." For example, you can walk, dance, bowl, bicycle, golf, swim--but if you have plans to jump out of an airplane anytime soon, better cancel. Things like jumping, running and jogging, bungee jumping and hang gliding are definitely no-nos. That's not to say some people with joint replacements don't do these things--they do. But just realize that such activities could cause harm to your joint, ruining all the good work you've done and putting you back in the hospital.

  Patient care begins with education and extends into rehabilitation and follow-up. Your role is to educate yourself, understand the system and follow through with all the steps the way they are designed in order to ensure the best possible outcome.

About the author:
Jan Revella, R.N., Arthritis Nurse Specialist, is founder and director of Arthritis Education by Professionals, Inc., based in Phoenix, Arizona. She is among the most prominent speakers and educators on the subject of arthritis in the United States. Her mission is to empower people with arthritis to use knowledge as power when making decisions about their personal healthcare. Arthritis Education by Professionals, Inc. provides educational programs and services to people with arthritis.

Criteria for Selecting a Surgeon for Joint Replacement

• Education
• Experience of the Surgeon
• Experience of the Surgical Team
• Number of Joint Replacements Done
• Success Rate
• Patient Data--10/15/20 Years Out

© Copyright 2005. Arthritis Education by Professionals, Inc.