“It’s All About Timing: Total Joint Replacements”
By Greg Zelden, PT, Director of Physical Therapy, Fairway Medical Surgical Hospital
When is it time to choose total joint replacement? Based solely on the personal nature of elective surgical procedures, one would anticipate their own need to elect surgical intervention. Yet, this is not a decision which is made easily; and, in some instances, the choice is made poorly. They wait too late.
Ignoring all of the additional factors like finances, assistance and time off work, the determination to complete total joint replacement surgery should be based upon physical necessity. Once it has been deemed an option by the orthopedic surgeon, most doctors will allow the patient to choose the time they wish to complete the procedure. This approach allows the patient to choose their own terms and doesn’t give the impression that the patient is being forced to a surgery. The problem is that some individuals will take this approach and avoid choosing. Meanwhile, over time the joint further deteriorates and the muscular structures and ligamentous tissue waste away. This leads to compensated posture with walking and undue stress on the remaining uninvolved joints of one’s leg and back.
Total joint replacement has progressed remarkably since years past. It is a means of eliminating the arthritic conditions which have effected a joint. Unfortunately, the joint is dependent upon its muscular and ligamentous flexibility. Surgery only changes the surfaces of the joint, not the muscular function or flexibility. If a person allows dramatic change to occur in the overlying soft tissue of an arthritic joint, even following joint replacement and rehabilitation, the limb may not achieve sufficient results. There may be continued pain, restrictions to motion and weakness effecting walking function.
So, when is it time for total joint replacement surgery after the physician has made the recommendation? When physical functional limitations alter the activity of daily living. For example, the instances when a person either avoids or compensates the function of those mundane aspects of daily life. Inability to run a marathon is not need for total joint, but inability to squat and reach to the bottom cabinet in the kitchen is.
Pain would be a good factor for determination, except everyone has a different perception of pain. Many ignore the discomfort but have developed a walking pattern which is horribly compensated. These people indicate that the pain is not bad enough for surgery and they continue to push forward causing further deterioration of the joint structures that would otherwise have been fairly easy to rehabilitate following surgery. At the same time, there are those who complain of intense pain but can walk and complete stairs with no visible restrictions. Given the variance in a person’s perception of pain, the best determining factor is if you have to compensate to complete those things that you have done most all of your life.
Total joint replacement surgery is a big and important decision. Of the many factors which may influence the choice of this elected procedure, compensated physical function is the most prominent. The ability to walk into a store and the ability to hobble about as if a character from a monster movie are not the same. Choose before it is too late.
If you feel you would be a candidate for total joint replacement, please visit Fairway Medical’s website for a list of orthopedic physicians or for information about Fairway Medical Physical Therapy. www.fairwaymedical.com.
