Joint Preservation vs. Replacement: What’s Your Best Option?

How to maintain your mobility well beyond retirement

If you have recurring or chronic joint pain, you may think joint replacement surgery is your only option for relief. However, you may want to explore several less invasive options first to help maintain mobility as you age.

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With millions of baby boomers in the United States wanting to stay active into their 60s, 70s and beyond, much recent research has focused on joint health and replacement technology.

Experiencing joint pain doesn’t automatically mean that you should have a joint replacement. Joint replacement surgery is generally performed for late stages of degenerative arthritis (also called osteoarthritis), after other options have failed. Most causes for hip pain can be treated with far less  invasive options.

So how do you know your arthritis or other joint damage needs attention? In general, you should see a doctor if your joint pain limits your activities for more than three days without improvement, or you have recurring episodes of the same pain over several weeks or months.

Read on to find out where you fall on the continuum of joint care.

Causes of joint pain

You can damage a joint suddenly. Or joint damage may come on gradually, bothering you periodically at first and becoming more painful over time.

The causes of joint pain may include:

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Most joint causes for joint pain never require surgery. However, even in the case of osteoarthritis, surgery is not the first choice. Whatever the cause, you’ll want to preserve your joints for as long as you can.

This is particularly true if you are a younger, active person.

Joint replacement has gotten much safer and faster to recover from. You may leave the hospital on the same day or one day after surgery, but these are serious operations that are not to be undertaken lightly, says orthopedic surgeon Anthony Miniaci, MD.

Joint replacement parts last longer than they used to. But they are mechanical and subject to loosening, stiffness, complications and infection. These problems may lead to follow-up surgeries down the road.

“Most people now live into their 80s. Many of the next generation will live to be older than 100,” Dr. Miniaci says. “If someone in their 50s is very active and has knee or hip joint replacement, they may need one or two more operations in their lifetime, so we try to avoid it until later if possible.”

Weighing the options for joint preservation, despite osteoarthritis

The goal of preservation is to prevent injury, reduce inflammation and preserve cartilage, Dr. Miniaci says. These factors figure in when your physician weighs your options:

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  • Age — Preservation techniques often are more successful for younger patients.
  • Weight — The more a patient weighs, the greater stress and demand is placed on a joint. Every pound a patient loses relieves three to five pounds of pressure on the hip, knee or ankle.  Losing weight is the kindest thing one can do for an arthritic joint.
  • Muscle strength and conditioning — Muscles provide power to movement.  They also serve as shock absorbers, protecting our joints. Maintaining or restoring muscle strength and flexibility reduces joint stress and pain.
  • Severity — Your doctor may sometimes manage small areas of cartilage thinning or erosion with minimally invasive procedures.  However, if the cartilage is almost all gone — leaving bone touching bone, or if the bone underneath the cartilage is deteriorating, surgery is sometimes the best option.
  • Location — Many joint preservation techniques focus on the knees. But there are an increasing number of alternatives to hip replacement as well. There are fewer alternatives to treat joint pain in the shoulder.

Non-surgical options for treating joint pain

Some joint preservation procedures are newer and considered experimental, Dr. Miniaci says. Physicians have used other preservation techniques for decades. Options, he says, include: 

  1. Injections — Injections of hyaluronic acid, corticosteroids can reduce inflammation in many patients in the lining of the joints. These treatments can work in most joints and have been well-studied. All are covered by most insurance carriers, with limitations.
  2. Platelet-rich plasma — Your blood contains platelets — hundreds of thousands of platelets are present in every milliliter of blood. Platelets are small cell fragments that release chemicals that induce blood clots that prevent bleeding. They also contain chemicals that can stimulate tissue repair and scarring. Many clinicians have begun using injections of concentrated platelets from blood called platelet-rich plasma (PRP) to treat inflamed or injured tendons, ligaments, muscle and joints. These treatments have been widely reported to be successful in some centers and unsuccessful in others. There are many methods to create PRP from blood. As yet, these therapies appear more effective for soft tissue problems than for joint problems.  However, there is no clear consensus about how and when they are most effective, or how lasting the effects are.  PRP therapy is not covered by insurance companies. However, you and your doctor can consider using PRP as a rational means of improving joint pain in many settings, where other options have proven to be unsuccessful.
  3. Cellular “stem-cell” injections — It is possible to collect tissue from one part of the body and transplant that tissue to another part. Bone marrow and fat can contain progenitor cells that are capable of forming new tissue, such as bone or cartilage. These cells are often called “stem cells” in the media and in advertisements for “stem cell clinics.” Even cells from babies that are present in amniotic fluid have been proposed as a source for cells that may reduce inflammation or restore or protect cartilage. None of these treatments are yet proven. Many of these treatments are worth studying in clinical trials. Some, like bone marrow, may have a very low risk of doing harm. However, none of these treatments are currently covered by insurance carriers. As a result, only a small number of patients currently feel that the cost is worth the try. If ongoing studies prove that “stem cell” injections can reliably prevent progression of arthritis or reverse arthritis and prevent joint replacement, these therapies would be well worth using.
  4. Cartilage transplant – In this technique, your treatment team will grow cartilage and place it in the damaged space or will stimulate the bone in your joint to increase cartilage growth. This works best for hips and knees and less so for shoulders.
  5. Partial replacement – Physicians use this technique when there is damage to a small part of the joint. The surgeon can preserve most of the bone and use smaller artificial parts to replace particular sections of joint. This treatment works in many joints, but must be used carefully. Replacement in one part of the joint does not necessarily prevent degeneration in other parts of the joint. As a result, partial replacements do not last as long as joint replacement procedures that involve the entire cartilage surface.

The benefits of full joint replacement

If you’ve unsuccessfully attempted conservative treatment or if damage to the cartilage or bone is beyond repair, remember that joint replacement is proven to be safe and highly effective in the right patient. This is still often is your best option.

This surgery can dramatically relieve your pain and improve your joint’s function. However, there are always potential risks and complications with surgery.

Talk with your doctor about the best options and long-term strategies for you. Preserving your joints and your activities and lifestyle is the basis for the partnership that is best for you.

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