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Common Myths about Hip and Knee Replacements
Dr. Theodore Manson discusses the common myths and reasons surrounding hip and knee replacements.
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Learn more about Theodore Manson, MD
Theodore Manson, MD
Dr. Manson specializes in hip and knee replacement surgery and treatment of hip and knee arthritis.Learn more about Theodore Manson, MD
Transcription:
Common Myths about Hip and Knee Replacements
Prakash Chandran: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest.
Prakash: This episode is sponsored by the University of Maryland Joint Network. UM Joint Network surgeons are experts in total hip and knee replacements. Held to the highest standards of care, uM Joint Network surgeons produce better outcomes for patients compared to national averages, including lower infection rates and faster recovery times. The UM Joint Network, home to Maryland's leading joint replacement surgeons.
Prakash Chandran: Today's topic is common myths about hip and knee replacements. I'm Prakash Chandran. And my guest today is Dr. Theodore Manson, Associate Professor of Orthopedics at University of Maryland Medical System.
Dr. Manson, thank you so much for joining me today. I guess let's get started by just understanding a little bit more around the most common reasons you see people coming in for hip or knee replacements.
Dr. Theodore Manson: Sure. There's two reasons why people get a hip or knee replacement. The first one is pain that just makes it so that people can't do what they want to do on an everyday basis, whether that be climb stairs or, you know, getting in and out of a chair, getting in and out of the car, doing exercise, like walking with the way that they want, or errands and things like that. You know, the pain interferes with your everyday activities.
The second reason is instability of the hip or knee, feeling like the hip or the knee just gives way, it won't support you. People say, "Oh, you know, I trip over things more readily than I used to." And it's oftentimes subtle. It develops slowly over time. People don't notice it, but you're hip and your knee can become so unstable that you just can't rely on them to keep you upright without falling.
Prakash Chandran: Yeah. Just to expand on the pain piece a little bit. Is this normally arthritis pain? Because one of the things that I've heard is that as you get older, it's inevitable that arthritis pain is going to increase. So is this something that's true?
Dr. Theodore Manson: Well, I think that everybody who gets older gets some arthritis pain, and you have more stiffness in your joints and muscles. But there's a lot of people who have wear of the cartilage in the joints, the bumper that goes in between the bones. And for these folks, it's very different. The pain gets more and more intense as they get older to the point where it really, really makes people miserable and it interferes and takes over their life.
Prakash Chandran: So, you know, when we talk about the demographics of people that come in to see you for hip and knee replacements, are they the same? Are they different? Talk a little bit about that.
Dr. Theodore Manson: It's the same demographics for people who come in for a hip or knee replacement. By the time that most people get to a hip or knee replacement, they're usually in their 60s and older. I definitely have younger patients who, for whatever reason, have more advanced arthritis at an early age. Knee injuries are common in athletes or hip malformations as a child are a common reason why people get a hip replacement when they're younger, whereas most people who end up having the arthritis pain that's severe enough to warrant surgery are in their 60s. We do have a fair number of younger people who just make them so miserable that they opt for surgery earlier.
Prakash Chandran: Yeah. And that's one of the myths that we hear, right? That hip and knee replacement is only for elderly people. But what I'm hearing from you is that while the majority of people might be in that older demographic, you still have a younger cohort that really gets these replacements due to improving their quality of life and movement, isn't that correct?
Dr. Theodore Manson: Yes. We prefer to wait until people are over 60 to do hip and knee replacement in general. But that doesn't mean that you deny surgery to people who are miserable, just because they're not old enough, so to speak yet. So if people are really miserable and they have bone on bone arthritis of their hip or their knee and they're younger than 60, we'll certainly consider joint replacement.
Prakash Chandran: So for hip and knee replacement, talk a little bit about how long it lasts. One of the things that I have heard is that there's usually a 10-year lifespan to these replacements and then you have to get it readdressed. Is that true?
Dr. Theodore Manson: Well, I hear that all the time. And I think that comes from what surgeons told patients in the 1990s. It was just distributed word of mouth from patient to patient, but that's actually not true. And so modern hip and knee replacements are much more durable than they used to be. And the way to think about how long anything lasts is the way that the engineers, for instance, determine how long a bridge is going to last. They talk about a percent per year failure rate.
So for both hip and knee replacements, there's a 1% per year failure rate. So after 20 years, that means that you have a 20% risk of getting the hip or the knee replacement redone. It's kind of a glass half empty way of looking at it, but you have an 80% chance of not having joint replacement redone. There's some people that have troubles right after the hip or knee replacement and need it redone right away. There's some people that it lasts for a long time, I just redid a hip replacement on a guy who had his hip replaced in 1970. And he was a very young man, as you may expect at that point in time and we just redid it last month. And so it's very variable, but overall your odds are a 1% per year failure rate. So after 20 years, you have a 20% chance of having the hip or the knee redone.
Prakash Chandran: Got it. Okay. That's helpful. And I just wanted to talk a little bit about post-replacement lifestyle. I think a lot of people think that once you get a hip or knee replacement, you're pretty limited in what you can do with your life, especially if you're younger and you're playing sports that a lot of people kind of write that off to like, "Okay, I'm not doing that anymore." Can you speak to this a little bit?
Dr. Theodore Manson: Absolutely. And that comes from again, what we were telling patients in the 1990s. The materials in the 1990s hip and knee replacements were not as durable as they are now. And so we told patients, you should limit yourself. And you shouldn't do any running is what we used to tell people. You shouldn't do singles tennis, for instance. You shouldn't do a lot of exercise on the knee joint. And we no longer restrict patients that way.
I think that most joint replacement surgeons would say, "Hey, you shouldn't take up running marathons, but you can certainly jog for fitness and you can do any sporting event pretty much that you want to do." Each person is different and their ability to do those sports with a joint replacement may or may not be exactly as much as they want to do, but we don't typically restrict people.
So the big number one is that we used to tell people not to run. And now, we tell people, "Just use your judgment," and wouldn't do long distance running, as in marathons and things like that. But running for exercise on a moderate basis is I think just fine for most joint replacement surgeons and their patients in the United States.
Prakash Chandran: So let's talk a little bit about recovery time. I've heard mixed things. But I think sometimes you hear that bed rest is required after the surgery. And it's a really long road to getting better and getting back to that active lifestyle that we were just talking about. Can you speak to what the recovery time is normally like and if bed rest is required?
Dr. Theodore Manson: And we actually recommend against bed rest first off. Bed rest is never something that the orthopedic surgeon will advocate for because being more active after the joint replacement limits your chances of having complications like blood clots, pressure sores, pneumonia, urinary tract infections, all the things that people who are on bed rest get more frequently.
So we tell people you should not stay in bed. You should be up and moving as much as you feel comfortable doing it and immediately after the joint replacement. All the recovery protocols now are aimed towards getting people up and moving as soon as they can. So for instance, the patients who get a hip and knee replacement, nowadays they'll be doing, you know, steps in the hospital or the surgery center most frequently as part of their criteria for discharge. So a lot of folks will be discharged the same day of surgery, and they'll be doing some steps on the day of surgery. And then afterwards, we don't restrict you for what you do other than no swimming until the surgical incision heals, but you don't really have a whole lot of restrictions on activities. You don't really have a lot of restrictions on going back to work.
Everyone is different. And so we have some patients that are pretty debilitated when they get their hip or knee replacement and they take longer to recover. And then I have patients that are mowing the lawn the weekend after surgery. And so it's very variable how quickly you can recover. What's generally true, however, is no matter where you start, you will get better and you will recover the muscle strength in the leg. It's just a question of how long it would take.
Prakash Chandran: Yeah. And I imagine that a lot of that has to do with rehab afterwards and being proactive with that. Isn't that true?
Dr. Theodore Manson: Yes. And actually, we're proponents of rehabilitation, so to speak, prior to the surgery. And so particularly for patients getting a hip replacement, but also for knee replacement patients, we want them to front-load their physical therapy prior to the surgery. So they know all the tips and tricks for maneuvering after a joint replacement. So they're ready by the time they get their hip or knee replacement. They know what their challenges are going to be after the surgery and how to navigate those challenges to make it easy as possible for them.
So for instance, if I've got a shower that is a bathtub, "How do I get in and out of that shower safely?" You know, "Which leg do I lead with going up and down the stairs?" Those types of things. It's so much better if you just talk to a physical therapist prior to the surgery, so that you're ready to go after you get the surgery.
Prakash Chandran: You know, one of the things that I've heard narrowing in on a hip replacement is that usually, especially if you're a little older and you get a hip replacement, that's when things maybe start to go downhill a little bit, like maybe you break your hip, maybe you have some pain, you replace that hip and then things are never the same. What might you say to people that think that way for either themselves or for their loved ones?
Dr. Theodore Manson: I would disagree with that. You know, for people that have hip arthritis and they come to me and I ask them, "Tell me, relative to the hip that you had when you're 18 years old, if that hip is a 100%, what's your hip now?" And a lot of them say 5%, 20%, 30%. Most people top out at about 20% or 30% if they have bad hip arthritis. Then when they have the hip replacement and they come back a year after the hip replacement surgery. And I asked them that same question, I say, "Relative to an 18-year-old hip, what's your hip now?" The answers that we get are average in the 90th percentile. So patients will say, "My hip's 90%. My hip's 95% of an 18-year-old hip." And that's one of the really satisfying things about being a hip replacement surgeon now is that the results are pretty impressive for most patients. That's an average, and so not everybody gets that high, certainly. But on average, I think that most people when they answer that one question, "What percent of your 18-year-old hip are you?" They'd say, you know, "Ninety-seven percent.".
For knee replacement, it's lower because the technology is not as mature. And so for knee replacement, patients, again, prior to the knee replacement, they say, "My knee is 5% all the way up to 30 or 40% of an 18-year-old's knee." Afterwards, they'd say it's mid-80s for the given knee. So let's say my knee is about 85%, you know, some people stretching up to 90%, 95% of an 18-year-old's knee, but the average is probably in the mid-80s.
Prakash Chandran: Got it. Well, that is extremely reassuring to hear. This has been a really fascinating conversation that's I think debunked a lot of things, at least in my mind. Is there anything else that you want to share with our audience around, you know, common myths around hip or knee replacements?
Dr. Theodore Manson: Another common myth is "Can I get an MRI if I've had a hip or knee replacement?" And the answer is yes. You can actually get an MRI of the hip or knee replacement itself using special techniques, but you can certainly get an MRI of other areas. So for instance, if you needed an MRI of your shoulder, for instance, you could get a shoulder MRI, even though you have a hip or knee replacement in place.
Prakash Chandran: Well, Dr. Manson, thank you so much again for your time. Any the other final words just around staying proactive, especially when it comes to your hip and knee health?
Dr. Theodore Manson: Sure. You know, most patients ask what's the best exercise for hips and knees, and it tends to be actually the lower impact activities like walking and biking. Running is great exercise, but it does tend to be harder for a lot of folks on their hips and knees as they get older, if you like running and you can do it, keep at it. But there's other things to consider, such as walking, inclined training. Where you're walking up hill, either outside on the street or on a specialized inclined trainer, which is a treadmill that basically slopes upward from, an incline of 10% to 40% is an excellent thing to do.
A lot of knee replacement patients in particular or patients with knee arthritis like to use an exercise bike. They find that that's a great way to get. A little bit of extra exercise. And then swimming is fantastic, particularly for people who have severe arthritis. Swimming, if you think about it, it takes the effects of gravity out of the picture, or lessens them to a certain extent. And so it's a great exercise for folks that have arthritis.
Prakash Chandran: Well, Dr. Manson, thank you again so much for your time today.
Host: find more podcasts just like this one visit umms.org/podcasts. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.
Common Myths about Hip and Knee Replacements
Prakash Chandran: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest.
Prakash: This episode is sponsored by the University of Maryland Joint Network. UM Joint Network surgeons are experts in total hip and knee replacements. Held to the highest standards of care, uM Joint Network surgeons produce better outcomes for patients compared to national averages, including lower infection rates and faster recovery times. The UM Joint Network, home to Maryland's leading joint replacement surgeons.
Prakash Chandran: Today's topic is common myths about hip and knee replacements. I'm Prakash Chandran. And my guest today is Dr. Theodore Manson, Associate Professor of Orthopedics at University of Maryland Medical System.
Dr. Manson, thank you so much for joining me today. I guess let's get started by just understanding a little bit more around the most common reasons you see people coming in for hip or knee replacements.
Dr. Theodore Manson: Sure. There's two reasons why people get a hip or knee replacement. The first one is pain that just makes it so that people can't do what they want to do on an everyday basis, whether that be climb stairs or, you know, getting in and out of a chair, getting in and out of the car, doing exercise, like walking with the way that they want, or errands and things like that. You know, the pain interferes with your everyday activities.
The second reason is instability of the hip or knee, feeling like the hip or the knee just gives way, it won't support you. People say, "Oh, you know, I trip over things more readily than I used to." And it's oftentimes subtle. It develops slowly over time. People don't notice it, but you're hip and your knee can become so unstable that you just can't rely on them to keep you upright without falling.
Prakash Chandran: Yeah. Just to expand on the pain piece a little bit. Is this normally arthritis pain? Because one of the things that I've heard is that as you get older, it's inevitable that arthritis pain is going to increase. So is this something that's true?
Dr. Theodore Manson: Well, I think that everybody who gets older gets some arthritis pain, and you have more stiffness in your joints and muscles. But there's a lot of people who have wear of the cartilage in the joints, the bumper that goes in between the bones. And for these folks, it's very different. The pain gets more and more intense as they get older to the point where it really, really makes people miserable and it interferes and takes over their life.
Prakash Chandran: So, you know, when we talk about the demographics of people that come in to see you for hip and knee replacements, are they the same? Are they different? Talk a little bit about that.
Dr. Theodore Manson: It's the same demographics for people who come in for a hip or knee replacement. By the time that most people get to a hip or knee replacement, they're usually in their 60s and older. I definitely have younger patients who, for whatever reason, have more advanced arthritis at an early age. Knee injuries are common in athletes or hip malformations as a child are a common reason why people get a hip replacement when they're younger, whereas most people who end up having the arthritis pain that's severe enough to warrant surgery are in their 60s. We do have a fair number of younger people who just make them so miserable that they opt for surgery earlier.
Prakash Chandran: Yeah. And that's one of the myths that we hear, right? That hip and knee replacement is only for elderly people. But what I'm hearing from you is that while the majority of people might be in that older demographic, you still have a younger cohort that really gets these replacements due to improving their quality of life and movement, isn't that correct?
Dr. Theodore Manson: Yes. We prefer to wait until people are over 60 to do hip and knee replacement in general. But that doesn't mean that you deny surgery to people who are miserable, just because they're not old enough, so to speak yet. So if people are really miserable and they have bone on bone arthritis of their hip or their knee and they're younger than 60, we'll certainly consider joint replacement.
Prakash Chandran: So for hip and knee replacement, talk a little bit about how long it lasts. One of the things that I have heard is that there's usually a 10-year lifespan to these replacements and then you have to get it readdressed. Is that true?
Dr. Theodore Manson: Well, I hear that all the time. And I think that comes from what surgeons told patients in the 1990s. It was just distributed word of mouth from patient to patient, but that's actually not true. And so modern hip and knee replacements are much more durable than they used to be. And the way to think about how long anything lasts is the way that the engineers, for instance, determine how long a bridge is going to last. They talk about a percent per year failure rate.
So for both hip and knee replacements, there's a 1% per year failure rate. So after 20 years, that means that you have a 20% risk of getting the hip or the knee replacement redone. It's kind of a glass half empty way of looking at it, but you have an 80% chance of not having joint replacement redone. There's some people that have troubles right after the hip or knee replacement and need it redone right away. There's some people that it lasts for a long time, I just redid a hip replacement on a guy who had his hip replaced in 1970. And he was a very young man, as you may expect at that point in time and we just redid it last month. And so it's very variable, but overall your odds are a 1% per year failure rate. So after 20 years, you have a 20% chance of having the hip or the knee redone.
Prakash Chandran: Got it. Okay. That's helpful. And I just wanted to talk a little bit about post-replacement lifestyle. I think a lot of people think that once you get a hip or knee replacement, you're pretty limited in what you can do with your life, especially if you're younger and you're playing sports that a lot of people kind of write that off to like, "Okay, I'm not doing that anymore." Can you speak to this a little bit?
Dr. Theodore Manson: Absolutely. And that comes from again, what we were telling patients in the 1990s. The materials in the 1990s hip and knee replacements were not as durable as they are now. And so we told patients, you should limit yourself. And you shouldn't do any running is what we used to tell people. You shouldn't do singles tennis, for instance. You shouldn't do a lot of exercise on the knee joint. And we no longer restrict patients that way.
I think that most joint replacement surgeons would say, "Hey, you shouldn't take up running marathons, but you can certainly jog for fitness and you can do any sporting event pretty much that you want to do." Each person is different and their ability to do those sports with a joint replacement may or may not be exactly as much as they want to do, but we don't typically restrict people.
So the big number one is that we used to tell people not to run. And now, we tell people, "Just use your judgment," and wouldn't do long distance running, as in marathons and things like that. But running for exercise on a moderate basis is I think just fine for most joint replacement surgeons and their patients in the United States.
Prakash Chandran: So let's talk a little bit about recovery time. I've heard mixed things. But I think sometimes you hear that bed rest is required after the surgery. And it's a really long road to getting better and getting back to that active lifestyle that we were just talking about. Can you speak to what the recovery time is normally like and if bed rest is required?
Dr. Theodore Manson: And we actually recommend against bed rest first off. Bed rest is never something that the orthopedic surgeon will advocate for because being more active after the joint replacement limits your chances of having complications like blood clots, pressure sores, pneumonia, urinary tract infections, all the things that people who are on bed rest get more frequently.
So we tell people you should not stay in bed. You should be up and moving as much as you feel comfortable doing it and immediately after the joint replacement. All the recovery protocols now are aimed towards getting people up and moving as soon as they can. So for instance, the patients who get a hip and knee replacement, nowadays they'll be doing, you know, steps in the hospital or the surgery center most frequently as part of their criteria for discharge. So a lot of folks will be discharged the same day of surgery, and they'll be doing some steps on the day of surgery. And then afterwards, we don't restrict you for what you do other than no swimming until the surgical incision heals, but you don't really have a whole lot of restrictions on activities. You don't really have a lot of restrictions on going back to work.
Everyone is different. And so we have some patients that are pretty debilitated when they get their hip or knee replacement and they take longer to recover. And then I have patients that are mowing the lawn the weekend after surgery. And so it's very variable how quickly you can recover. What's generally true, however, is no matter where you start, you will get better and you will recover the muscle strength in the leg. It's just a question of how long it would take.
Prakash Chandran: Yeah. And I imagine that a lot of that has to do with rehab afterwards and being proactive with that. Isn't that true?
Dr. Theodore Manson: Yes. And actually, we're proponents of rehabilitation, so to speak, prior to the surgery. And so particularly for patients getting a hip replacement, but also for knee replacement patients, we want them to front-load their physical therapy prior to the surgery. So they know all the tips and tricks for maneuvering after a joint replacement. So they're ready by the time they get their hip or knee replacement. They know what their challenges are going to be after the surgery and how to navigate those challenges to make it easy as possible for them.
So for instance, if I've got a shower that is a bathtub, "How do I get in and out of that shower safely?" You know, "Which leg do I lead with going up and down the stairs?" Those types of things. It's so much better if you just talk to a physical therapist prior to the surgery, so that you're ready to go after you get the surgery.
Prakash Chandran: You know, one of the things that I've heard narrowing in on a hip replacement is that usually, especially if you're a little older and you get a hip replacement, that's when things maybe start to go downhill a little bit, like maybe you break your hip, maybe you have some pain, you replace that hip and then things are never the same. What might you say to people that think that way for either themselves or for their loved ones?
Dr. Theodore Manson: I would disagree with that. You know, for people that have hip arthritis and they come to me and I ask them, "Tell me, relative to the hip that you had when you're 18 years old, if that hip is a 100%, what's your hip now?" And a lot of them say 5%, 20%, 30%. Most people top out at about 20% or 30% if they have bad hip arthritis. Then when they have the hip replacement and they come back a year after the hip replacement surgery. And I asked them that same question, I say, "Relative to an 18-year-old hip, what's your hip now?" The answers that we get are average in the 90th percentile. So patients will say, "My hip's 90%. My hip's 95% of an 18-year-old hip." And that's one of the really satisfying things about being a hip replacement surgeon now is that the results are pretty impressive for most patients. That's an average, and so not everybody gets that high, certainly. But on average, I think that most people when they answer that one question, "What percent of your 18-year-old hip are you?" They'd say, you know, "Ninety-seven percent.".
For knee replacement, it's lower because the technology is not as mature. And so for knee replacement, patients, again, prior to the knee replacement, they say, "My knee is 5% all the way up to 30 or 40% of an 18-year-old's knee." Afterwards, they'd say it's mid-80s for the given knee. So let's say my knee is about 85%, you know, some people stretching up to 90%, 95% of an 18-year-old's knee, but the average is probably in the mid-80s.
Prakash Chandran: Got it. Well, that is extremely reassuring to hear. This has been a really fascinating conversation that's I think debunked a lot of things, at least in my mind. Is there anything else that you want to share with our audience around, you know, common myths around hip or knee replacements?
Dr. Theodore Manson: Another common myth is "Can I get an MRI if I've had a hip or knee replacement?" And the answer is yes. You can actually get an MRI of the hip or knee replacement itself using special techniques, but you can certainly get an MRI of other areas. So for instance, if you needed an MRI of your shoulder, for instance, you could get a shoulder MRI, even though you have a hip or knee replacement in place.
Prakash Chandran: Well, Dr. Manson, thank you so much again for your time. Any the other final words just around staying proactive, especially when it comes to your hip and knee health?
Dr. Theodore Manson: Sure. You know, most patients ask what's the best exercise for hips and knees, and it tends to be actually the lower impact activities like walking and biking. Running is great exercise, but it does tend to be harder for a lot of folks on their hips and knees as they get older, if you like running and you can do it, keep at it. But there's other things to consider, such as walking, inclined training. Where you're walking up hill, either outside on the street or on a specialized inclined trainer, which is a treadmill that basically slopes upward from, an incline of 10% to 40% is an excellent thing to do.
A lot of knee replacement patients in particular or patients with knee arthritis like to use an exercise bike. They find that that's a great way to get. A little bit of extra exercise. And then swimming is fantastic, particularly for people who have severe arthritis. Swimming, if you think about it, it takes the effects of gravity out of the picture, or lessens them to a certain extent. And so it's a great exercise for folks that have arthritis.
Prakash Chandran: Well, Dr. Manson, thank you again so much for your time today.
Host: find more podcasts just like this one visit umms.org/podcasts. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.