Total joint replacement may be appropriate for people who have severe joint pain resulting from arthritis or other joint disorders. Normally it is considered after other options such as medication or therapy are no longer effective in controlling pain and improving mobility.
Emory's experienced, board-certified orthopedic surgeons use the most advanced equipment and resources available to ensure the best possible treatment for a wide range of conditions affecting the joints.
In this podcast Orthopaedic Surgeon George Guild, MD discusses some common causes of joint pain and how if severe pain or joint damage limits your daily activities, it might be time to consider a joint replacement.
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When is the Right Time to Consider Total Joint Replacement Surgery?
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Learn more about George N. Guild III, MD
George N. Guild III, MD
George N. Guild III, MD, is an orthopedic surgeon focused on adult hip and knee reconstruction at Emory Healthcare in Atlanta. He is a member of the American Academy of Orthopaedic Surgeons, American Academy of Hip and Knee Surgeons and International Congress of Joint Reconstruction. He has previously helped develop a contemporary outpatient total joint replacement center at both Northside Hospital Atlanta and Peachtree Orthopaedic Surgery Center in Atlanta.Learn more about George N. Guild III, MD
Transcription:
Bill Klaproth (Host): If you’re suffering from chronic joint pain, when is it time to consider joint replacement surgery and what do you need to know? So, here to talk with us about total joint replacement surgery is Dr. George Guild, an orthopedic surgeon at Emory Healthcare. Dr. Guild, thank you so much for your time today. So, let’s jump into this. When is it time to consider total joint replacement surgery?
Dr. George Guild, MD (Guest): Fantastic question and the answer is pretty straightforward. If you’re over 50, and you have pain with weight bearing in your hip or knee that’s been refractory to anti-inflammatories such as Aleve or ibuprofen or an injection, then it really is time to consult your orthopedic surgeon or total joint specialist to chat about surgery.
Bill: So someone over 50 who has the symptoms as you just described, that would be a good candidate, then, for total joint replacement surgery?
Dr. Guild: As long as the x-rays themselves show a degeneration of the joint, which we typically refer to as osteoarthritis, or what I sometimes call “Vanilla Arthritis”; wear and tear arthritis would be another term where the joint range of motion becomes limited and on x-ray you’ll see a collapse of the joint space. So, someone who comes in with those constellation of findings, typically is an excellent candidate for replacement.
Bill: And if someone is thinking about this or weighing their options, what are the benefits of total joint replacement surgery?
Dr. Guild: It’s a great question once again, and it’s a big decision in one’s life to, you know, remove with a prosthetic joint replacement. The two biggest goals are resolution of pain and improving function, which is a broad term, but typically getting back to doing activities of daily living and getting back to certain athletic activities like tennis, golf, bowling, travel, and just enjoying a quality of life again. These are the typical goals of joint replacement.
Bill: And Dr. Guild, I’m just wondering about this. Is there generally a mental hurdle people have to get over before accepting that this is the best option for them?
Dr. Guild: Yes. The psychology of surgery is alive and well, and it’s a conversation I probably have on a daily basis. You know, sometimes people don’t want to admit that maybe they’re getting a little bit older, and something on their body is wearing out, and certainly we do not encourage anyone to rush into surgery. A typical conversation would really emphasize non-surgical management for a period of time. So, when people can’t walk without pain, they can’t get up and down stairs without pain; walking to the car to go to the grocery store is hard – then they really start —it really sinks in that it’s time to go ahead and get this fixed.
Bill: Right. So, functionally when you’re just trying to get through everyday life, even, you know, reaching up to a cabinet to get a can down out of the shelf. If you’re in constant pain, it really affects your quality of life on a daily basis, right?
Dr. Guild: That’s true, and that’s very accurate and common, you know, to be honest with you.
Bill: So, Dr. Guild, what are the risks, then, involved in joint replacement surgery?
Dr. Guild: You know, there are a few that are particular to the hip and the knee. There’s some that are risks for both hip and knee. So, one of the biggest things we concentrate on is infection prevention, and you know, an average infection rate would be 1 to 2%, but really, we’ve done some things that are a little more progressive that we’re publishing on now to get that rate down to zero or very near 0.0. You know, if you’re doing thousands of these joint replacements at a center in a year, you really need to get that rate low and that includes putting antibiotics in the hip or knee itself as well as in the IV at time of surgery, and with some of these techniques we’ve seen extremely low infection rates, which can be one of the most common causes of failure depending on where you have it. Other risks can be stiffness, you know. So, you need physical therapy afterwards — a joint that’s unstable, and clearly that kind of depends on patient characteristics and your surgeon, and then avoiding blood clots, which we typically just do a baby aspirin twice a day, but those are some standard risks after joint replacement. They’re typically all less than 1% chance.
Bill: Which is very good news, and then how long does a new joint usually last?
Dr. Guild: The answer is, if you look at historical data, the answer is 20 years. The implants of today are different than they were. There was a change around 2002 in the quality of the plastic that we use and so with newer plastics and techniques on a simulator, you’ll see it last 46 years. So, a joint that’s put in properly, the longevity is much longer than it used to be.
Bill: So, someone that’s 58 and gets a hip replacement, that joint replacement could last them well into their 80’s?
Dr. Guild: That’s correct, and we’re not anticipating those really wearing out. We’ve got great data now. Some of the data actually goes beyond 20 years. We’re not totally sure what happens after 30 years yet because some of these newer implants just haven’t been on the market that long, but the preliminary results are not showing a lot of wear, whereas for a 58-year-old as you mentioned might be the last surgery they ever have on their hip.
Bill: And that would certainly play into the decision to get total joint replacement surgery. So, what should someone expect before and after the surgery?
Dr. Guild: Yes. So beforehand, typical things you’ve got to prepare your house. So, if you have a lot of steps, especially inside the house, you might want to try to arrange to live on one level. You can do stairs typically the day after surgery, but you’re not going to feel like doing them every day. So, if you can get a sofa or a bed near the kitchen and a bathroom, that’s typically a good idea. You want to have some meals prepared, just depending if you’re the one who cooks or depending on someone who helps you out, and then having a “care partner”; someone who can kind of go through it with you is very important. Those things you definitely should do ahead of time, and then preparing for after surgery, oftentimes, physical therapy will come in your house three times a week for the first three weeks. Then you’ll go to physical therapy for three weeks and by six weeks, you’re basically recovered.
Bill: Wow. That’s really good news. So, yeah, I know, this is specific to the joint and patient, but the recovery period then, generally six weeks?
Dr. Guild: Yeah. It’s six weeks, and so just to give you an idea, the day of surgery, many patients will walk 150 feet, and they’ll be able to get up some stairs the same day. You typically need a walker at first for balance for about the first two weeks, and then most patients by week three need no ambulatory assistance at all. Especially a hip. A knee, you might need a cane at three weeks. By six weeks you would not need any ambulatory assistive device for hip or knee, and people will reliably say that their hip or knee feels much better than before surgery at six weeks’ time. That’s true.
Bill: That’s so good. I bet you often hear stories of people saying that waited for a long time to do this, and then had the total joint replacement surgery and came back to you and said, I should have done this sooner! I’m sure you hear those stories.
Dr. Guild: Very common thing to say, and it kind of plays into your previous question. Some of the psychology behind surgery, and I think it’s appropriate to have a fear of the unknown or, you know, just fear of surgery and not being in control of the situation, and people will postpone having surgery, and they’ll literally drag their leg around for years, and then once they have a good functioning joint, they’re very grateful, and some people wait too long, which is a totally separate problem. Someone who waits too long, let’s say, they used to walk without anything. Now they need a cane. Now they need a walker. Now, they’re kind of walker/wheelchair, those are the folks that are tough. They’ve probably waited a little too long where they’ve gotten more debilitated than would have otherwise been necessary.
Bill: So, what happens in that case? So, say you do a knee replacement, everything else around the knee is atrophied to the point that the new knee doesn’t really help right away?
Dr. Guild: Well, it can be a much longer rehab. So, those folks often will need to go to a rehab center, which we don’t necessarily like to do if we can help it, and you know, you can imagine all those years and time that the muscles and everything atrophied, got weak. It can be an equal amount of time getting better. So, those folks, their recovery is not going to be six weeks when they get that debilitated. You can expect months and months recovery if you wait too long.
Bill: So, that’s good to know. So. The message is, don’t wait, go see your orthopedic surgeon and get that joint wherever it is checked out. Well, Dr. Guild, thank you so much for spending some time with us today talking about total joint replacement surgery. We appreciate it. For more information, please visit emoryhealthcare.org. That's emoryhealthcare.org. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): If you’re suffering from chronic joint pain, when is it time to consider joint replacement surgery and what do you need to know? So, here to talk with us about total joint replacement surgery is Dr. George Guild, an orthopedic surgeon at Emory Healthcare. Dr. Guild, thank you so much for your time today. So, let’s jump into this. When is it time to consider total joint replacement surgery?
Dr. George Guild, MD (Guest): Fantastic question and the answer is pretty straightforward. If you’re over 50, and you have pain with weight bearing in your hip or knee that’s been refractory to anti-inflammatories such as Aleve or ibuprofen or an injection, then it really is time to consult your orthopedic surgeon or total joint specialist to chat about surgery.
Bill: So someone over 50 who has the symptoms as you just described, that would be a good candidate, then, for total joint replacement surgery?
Dr. Guild: As long as the x-rays themselves show a degeneration of the joint, which we typically refer to as osteoarthritis, or what I sometimes call “Vanilla Arthritis”; wear and tear arthritis would be another term where the joint range of motion becomes limited and on x-ray you’ll see a collapse of the joint space. So, someone who comes in with those constellation of findings, typically is an excellent candidate for replacement.
Bill: And if someone is thinking about this or weighing their options, what are the benefits of total joint replacement surgery?
Dr. Guild: It’s a great question once again, and it’s a big decision in one’s life to, you know, remove with a prosthetic joint replacement. The two biggest goals are resolution of pain and improving function, which is a broad term, but typically getting back to doing activities of daily living and getting back to certain athletic activities like tennis, golf, bowling, travel, and just enjoying a quality of life again. These are the typical goals of joint replacement.
Bill: And Dr. Guild, I’m just wondering about this. Is there generally a mental hurdle people have to get over before accepting that this is the best option for them?
Dr. Guild: Yes. The psychology of surgery is alive and well, and it’s a conversation I probably have on a daily basis. You know, sometimes people don’t want to admit that maybe they’re getting a little bit older, and something on their body is wearing out, and certainly we do not encourage anyone to rush into surgery. A typical conversation would really emphasize non-surgical management for a period of time. So, when people can’t walk without pain, they can’t get up and down stairs without pain; walking to the car to go to the grocery store is hard – then they really start —it really sinks in that it’s time to go ahead and get this fixed.
Bill: Right. So, functionally when you’re just trying to get through everyday life, even, you know, reaching up to a cabinet to get a can down out of the shelf. If you’re in constant pain, it really affects your quality of life on a daily basis, right?
Dr. Guild: That’s true, and that’s very accurate and common, you know, to be honest with you.
Bill: So, Dr. Guild, what are the risks, then, involved in joint replacement surgery?
Dr. Guild: You know, there are a few that are particular to the hip and the knee. There’s some that are risks for both hip and knee. So, one of the biggest things we concentrate on is infection prevention, and you know, an average infection rate would be 1 to 2%, but really, we’ve done some things that are a little more progressive that we’re publishing on now to get that rate down to zero or very near 0.0. You know, if you’re doing thousands of these joint replacements at a center in a year, you really need to get that rate low and that includes putting antibiotics in the hip or knee itself as well as in the IV at time of surgery, and with some of these techniques we’ve seen extremely low infection rates, which can be one of the most common causes of failure depending on where you have it. Other risks can be stiffness, you know. So, you need physical therapy afterwards — a joint that’s unstable, and clearly that kind of depends on patient characteristics and your surgeon, and then avoiding blood clots, which we typically just do a baby aspirin twice a day, but those are some standard risks after joint replacement. They’re typically all less than 1% chance.
Bill: Which is very good news, and then how long does a new joint usually last?
Dr. Guild: The answer is, if you look at historical data, the answer is 20 years. The implants of today are different than they were. There was a change around 2002 in the quality of the plastic that we use and so with newer plastics and techniques on a simulator, you’ll see it last 46 years. So, a joint that’s put in properly, the longevity is much longer than it used to be.
Bill: So, someone that’s 58 and gets a hip replacement, that joint replacement could last them well into their 80’s?
Dr. Guild: That’s correct, and we’re not anticipating those really wearing out. We’ve got great data now. Some of the data actually goes beyond 20 years. We’re not totally sure what happens after 30 years yet because some of these newer implants just haven’t been on the market that long, but the preliminary results are not showing a lot of wear, whereas for a 58-year-old as you mentioned might be the last surgery they ever have on their hip.
Bill: And that would certainly play into the decision to get total joint replacement surgery. So, what should someone expect before and after the surgery?
Dr. Guild: Yes. So beforehand, typical things you’ve got to prepare your house. So, if you have a lot of steps, especially inside the house, you might want to try to arrange to live on one level. You can do stairs typically the day after surgery, but you’re not going to feel like doing them every day. So, if you can get a sofa or a bed near the kitchen and a bathroom, that’s typically a good idea. You want to have some meals prepared, just depending if you’re the one who cooks or depending on someone who helps you out, and then having a “care partner”; someone who can kind of go through it with you is very important. Those things you definitely should do ahead of time, and then preparing for after surgery, oftentimes, physical therapy will come in your house three times a week for the first three weeks. Then you’ll go to physical therapy for three weeks and by six weeks, you’re basically recovered.
Bill: Wow. That’s really good news. So, yeah, I know, this is specific to the joint and patient, but the recovery period then, generally six weeks?
Dr. Guild: Yeah. It’s six weeks, and so just to give you an idea, the day of surgery, many patients will walk 150 feet, and they’ll be able to get up some stairs the same day. You typically need a walker at first for balance for about the first two weeks, and then most patients by week three need no ambulatory assistance at all. Especially a hip. A knee, you might need a cane at three weeks. By six weeks you would not need any ambulatory assistive device for hip or knee, and people will reliably say that their hip or knee feels much better than before surgery at six weeks’ time. That’s true.
Bill: That’s so good. I bet you often hear stories of people saying that waited for a long time to do this, and then had the total joint replacement surgery and came back to you and said, I should have done this sooner! I’m sure you hear those stories.
Dr. Guild: Very common thing to say, and it kind of plays into your previous question. Some of the psychology behind surgery, and I think it’s appropriate to have a fear of the unknown or, you know, just fear of surgery and not being in control of the situation, and people will postpone having surgery, and they’ll literally drag their leg around for years, and then once they have a good functioning joint, they’re very grateful, and some people wait too long, which is a totally separate problem. Someone who waits too long, let’s say, they used to walk without anything. Now they need a cane. Now they need a walker. Now, they’re kind of walker/wheelchair, those are the folks that are tough. They’ve probably waited a little too long where they’ve gotten more debilitated than would have otherwise been necessary.
Bill: So, what happens in that case? So, say you do a knee replacement, everything else around the knee is atrophied to the point that the new knee doesn’t really help right away?
Dr. Guild: Well, it can be a much longer rehab. So, those folks often will need to go to a rehab center, which we don’t necessarily like to do if we can help it, and you know, you can imagine all those years and time that the muscles and everything atrophied, got weak. It can be an equal amount of time getting better. So, those folks, their recovery is not going to be six weeks when they get that debilitated. You can expect months and months recovery if you wait too long.
Bill: So, that’s good to know. So. The message is, don’t wait, go see your orthopedic surgeon and get that joint wherever it is checked out. Well, Dr. Guild, thank you so much for spending some time with us today talking about total joint replacement surgery. We appreciate it. For more information, please visit emoryhealthcare.org. That's emoryhealthcare.org. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.