When to Consider Surgery for Hip and Knee Arthritis

by Rishi Gogineni, M.D.

When to Consider Surgery for Hip and Knee Arthritis

Arthritis is the umbrella term for damage to multiple parts of a joint in your body. You may have pain, weakness, grinding, stiffness in a joint due to arthritis. The most common cause of arthritis is wear and tear on a joint due to using the joint over a long period of time. Rheumatoid arthritis, caused by an autoimmune condition where your body attacks your own joints, and post-traumatic arthritis, caused by injuries such as fractures, are other types of arthritis. Arthritis may also be genetic and run in families.

When you start to notice symptoms, you should see your primary care doctor. Your primary care doctor can start the evaluation process and start some basic treatments before referring you to a specialist. Or, if your insurance allows, you may come directly to OrthoVirginia. We’re happy to help you from the start.

The first evaluation includes a good history of your symptoms: when your symptoms started, how they started, what works to relieve pain, what doesn’t relieve pain, what activities are the most uncomfortable? The history will be followed by a good physical exam of the patient and the specific body part that hurts. We will almost always get x-rays and may get advanced imaging such as an MRI or CT scan.

We start with conservative treatments like oral anti-inflammatory medications, physical therapy, ice, heat, braces, and injections. These treatments help many patients to avoid or delay surgery. However, for some patients, these conservative treatments don’t give them enough relief.

If patients have advanced arthritis or if patients don’t receive enough relief from conservative treatments, they should consider surgery. The patient and their surgeon make the decision to consider surgery together, and your surgeon can recommend the specific type of surgery and give you details about a surgery timeline for your condition.

Frequently Asked Questions

After a joint replacement, can I do the same activities I did before my joint replacement?

Most patients are able to get back to their prior level of activity after hip and knee replacements. Non-impact activities like walking on the golf course or cycling are completely fine for joint replacement patients. Some patients are even able to ski after hip or knee replacements. We don’t advise repetitive impact activities like long-distance running. We think that repetitive impact activities may cause your replacement joint to become loose sooner, but you can cycle as long and as far as you want and it shouldn’t affect your joint.

Can you be too young for a hip or knee replacement?

No, you cannot be too young for a joint replacement. Replacement joints only last a certain amount of time, so in the past we used to make sure patients were a minimum age before they had surgery. However, the thinking has changed. If a patient is young but has severe or advanced arthritis, and has exhausted all other treatments, they don’t have a choice and we don’t want the patient to suffer. We do let younger patients know they may need a revision surgery in the future.

How does physical therapy fit in?

Physical therapy is very good at improving the range of motion of a joint when the joint starts to get stiff. When people get arthritis, they start to get stiffness, weakness, and a loss of strength and coordination, and physical therapy can help to restore some of that function. It may or may not eliminate pain in an arthritic joint, but in almost all patients it improves their range of motion and functional level.

You don’t have to keep doing formal physical therapy with a physical therapist for a long period. You can learn the exercises and do them on your own.

Do steroids help with arthritis?

Yes, steroids help with arthritis. Steroids, a strong anti-inflammatory medication, are one of the mainstays of conservative treatment. Steroids are used to decrease inflammation in joints, which reduces the pain in those joints. The reduced pain allows patients to be much more functional and helps them do physical therapy more effectively.

Does the type of arthritis affect how you treat it?

No, the treatment for the actual arthritis is the same. The patient would be treated with conservative treatments first, and then if the conservative treatments didn’t provide enough relief surgery would be an option.

Who can get a cortisone shot? How long does the shot last?

Almost everyone can be a candidate for getting a cortisone injection. Patients who are diabetic need to know in advance that the shots may temporarily affect their blood sugar, but diabetic patients are able to get cortisone shots.

Gel injections are also given to many patients. Gel injections help patients more in early or moderate stages of arthritis and are not as helpful during later stages of arthritis. Gel injections may not be as readily approved by insurance.

How long an injection lasts depends on the person and the severity of their arthritis. The injection may provide temporary relief anywhere from a few days to over a year.