Every year thousands of people undergo joint replacement surgery. You probably know a few of them. You may even be thinking about getting one yourself. How do you know if you should have one or not? What can you expect? What will your doctor discuss with you and what are the risks involved? These are some of the issues I will try to address for you here.
When you first see your orthopaedic surgeon about a joint replacement he will ask you about other treatments you have had. He may try to get you to take some anti-inflammatory pills (aspirin like drugs) or use a cane. He is not putting you off, but merely doing his first job as a surgeon, which is to try and get you by without surgery. These treatments can be very effective in decreasing the symptoms of arthritis and make your joint pain tolerable. We surgeons advise our patients that if they can put up with their symptoms, they should continue to tolerate them for as long as possible. Only when the pain is unbearable should you undergo a joint replacement.
Why put off a joint replacement for so long?
The reason is simple. Joint replacements are a major surgery, and like all surgery, complications can occur. Unfortunately when complications do occur in joint surgery they are very serious problems. These complications are the same regardless of which surgeon does your surgery or which hospital it is done at. Some patient factors do make some complications more likely than others though.
What are these complications?
One is infection. One to two out of every hundred cases gets an infection. Infections usually come from the patient’s own skin. Sometimes the infections can be treated by antibiotics alone but very often the infection is too deep within the artificial joint and we must remove the joint altogether leaving the patient with no joint at all. Sometimes we can put another joint in later but not always.
Another complication is blood clots. Joint surgery and the immobilization afterwards tends to favour blood clots forming in the legs. Sometimes these blood clots can break off and travel into your lungs and heart and can cause serious damage, maybe even death. This happens about one out of every hundred cases. Your surgeon may talk with you about taking a blood thinner after your surgery to help prevent this but these drugs have problems too.
There is a chance that you might have to be given blood after your surgery. There is a chance that you might get a disease like AIDS from this. This occurs only in about one in a half million cases. About one in 100 000 cases will get another virus like hepatitis. These risks are very small but not zero.
Joint replacements can wear out too. Artificial joints are only metal and plastic and start to wear out as soon as they are put in. We like to tell our patients that new joints are like the new tires on your car. You have 50 000 miles before they wear out and you can drive these miles all in one year or you can spread them out over fifteen years. Likewise younger, healthier active people wear out joints faster than older, smaller less active people. Orthopaedic surgeons are very reluctant to do joint replacements on people less than 60 year old for this very reason. Most joint replacements are lasting 10 years but some people are less lucky and wear them out sooner in only a few years. It is possible to do surgery again to put a second or even a third joint in but the results are never as good as the first time around, the surgery is riskier and the joints last even less long. One should never get a joint replacement thinking that they can always get another in the future if the first does not turn out.
Some other things can happen such as dislocations of the joint (the joint comes apart) or damaging important blood vessels and nerves in the leg. This happens very infrequently (less than 1 in 100 cases) but can have serious consequences if it does.
Joint replacements are at best still only metal and plastic. Our technology is not yet good enough to return your knee to the way it was when you were twenty-five. We are merely trading a diseased joint for an artificial one. You will still have some minor pain from time to time but overall it should be better than it was. As long as it is better it is successful.
We as orthopaedic surgeons do not mean to frighten out patients by telling them these horror stories. The law requires us to discuss these risks without patients. I personally would discuss the risks even if the law did not require because I think it is a very good idea for patients to go into an operation with their eyes open. To put things into perspective, only a minority of patients (1 in 20) gets a complication. When they do however it is a serious one and they are not very happy. If their surgeon has not warned them about what could happen, they are very unhappy. However most patients (19 out of 20) do very well after their operation and are quite pleased with the results.
What you as a patient need to decide is whether your joint pain is bad enough that you are willing to take these risks or not. Every patient is different and only you can answer this question for yourself. I find that my patients once I give them all this information know in their hearts when it is the right time and it is often they who will tell me when it is time to get their joints replaced.
We as orthopaedic surgeons are trying to help relieve your pain and get you back to enjoying life. However, we are not perfect and you need to have realistic expectations about your surgery. Fortunately we are able to help most of the people most of the time.