These considerations describe why I've gone for the exercise "cure"--it's a better choice for me. So far exercise has given me major relief, but, like other choices in life, it's an everyday commitment.
Stiff, achy joints are no fun. But before you consider surgery, take these steps to find relief.
Debating getting a new hip, knee, or shoulder? Join the club. You
likely need both hands to count the number of friends who’ve already had
joint replacement surgery.
In 2018, over 1.2 million primary shoulder, hip, and knee joint
replacements were performed in the United States, says Neil P. Sheth,
M.D., chief of orthopedic surgery at Pennsylvania Hospital in
Philadelphia.
The fact that “total joint replacements have demonstrated excellent
long-term clinical results” is one reason for the procedure’s
popularity, says Dr. Sheth. The aging baby boomer population is another:
The older you get, the more your joints may deteriorate, or the more
likely a past joint injury begins to limit your mobility.
“As people over 65 become more active and want a better quality of
life, more are seeking total joint replacements,” says Stuart J.
Fischer, M.D., an orthopaedic surgeon in Summit, New Jersey. “Newer
techniques and longer-lasting components have made surgery a good option
for active patients.”
The Downsides of Joint Replacement Surgery
As exciting as the prospect of a brand-new joint can be, replacement
surgery doesn’t come without side effects. Although rare, complications
can include infections, blood clots, heart attacks, damage to blood
vessels or nerves, and instability or fracture around the implant, Dr.
Sheth says.
Most concerning, the risk for post-op complications goes up with age, according to a study in the Journal of the American Geriatrics Society.
It’s not necessarily your age that’s the problem, but the host of
chronic conditions that all too often go along with getting older, say
experts.
Factors like frailty, smoking, mental impairment, and depression can
also increase your risk of adverse outcomes after elective surgery,
according to a 2018 report in BMC Medicine.
Other evidence shows that shiny new joints don’t always deliver on
their promise. Looking at knee replacements, for example, one study
found that up to one-third of those who get a new knee continue to
experience chronic pain. While another report found that the common knee
surgery had “minimal effects” on quality of life.
And one in 37 women over the age of 85 who opt for a shoulder replacement will need a re-do within five years.
The good news? There are a number of proactive things you can do to stave off getting a joint replacement.
Delay Tactic #1: Go for a Walk
This might sound counterintuitive if you have painful joints, but
staying active is important. “Exercise will strengthen the muscles
around the joints and take some of the pressure off them,” explains Dr.
Fischer. “It will also help preserve motion in the joint if arthritis is
beginning to cause stiffness.”
Along with upping your outings, consider booking a series of sessions with a physical therapist.
PTs can show you how to exercise safely by modifying moves to work
within your range of motion and prevent further joint damage.
Dr. Sheth encourages patients to try joint-friendly exercises,
like swimming or riding a stationary bike, or using a stair stepper or
elliptical machine at the gym. “These gliding type activities may cause
less discomfort,” he says.
Practice patience. Studies looking at the benefits of exercise
programs for individuals with hip osteoarthritis, for example, found
that it takes about 12 weeks for pain levels to diminish and strength
and mobility to improve, according to the Arthritis Foundation.
A good beginning goal, says Dr. Fisher, is aiming for 20 to 30
minutes of exercise three to four times each week. Discover some of the
best physical therapist-approved exercises for your knees here, hips here, and shoulders here.
Delay Tactic #2: Step on the Scale
You can be thin and suffer from stiff, achy joints. But if you’re
carrying any excess weight, your joints definitely aren’t going to be
happy. That’s because being overweight or obese does more than damage
your heart, lungs, and liver, Dr. Sheth says. It also harms your joints.
It’s a matter of physics. Every time you take a step, your hips and knees experience additional force across those joints.
“If your joint is already arthritic, this will result in more pain
and potentially decrease the time over which your remaining cartilage
will wear out,” says Dr. Sheth.
For every pound you lose, you’ll take four pounds of pressure off your bad joints, according to a study in Arthritis and Rheumatology. If you’re about 10 pounds overweight, that could add up to 40 pounds of pressure taken off!
Of course, losing weight after the age of 60
isn’t as simple as cutting calories. Your body has specific nutritional
targets that you’ll need to hit in order to stay healthy.
Protein is especially important, since it helps preserve your muscle
mass. You’ll also want to make sure you continue to get enough
fiber—preferably in the form of vegetables, legumes, and whole
grains—for proper immune function and digestive health.
Check out these seven protein-packed vegetables
that can help you hit both targets. If you need more help, a registered
dietitian can set you up with a personalized meal plan that fits your
health needs and your individual tastes.
Delay Tactic #3: Take a Shot
Exercise and weight loss are the first steps to take if you want to
avoid surgery, but doctors also recommend taking over-the-counter
anti-inflammatory medication and applying ice or heat to help alleviate
acute pain.
If those remedies aren’t enough or aren’t safe for you to try, your
doctor may suggest a series of injections, spaced a few months apart,
for a limited time. There are two main types:
- Corticosteroid (steroid) injections are used to calm inflammation and minimize pain and swelling in the affected area.
- Hyaluronic (HA) injections are approved by the Food
and Drug Administration (FDA) to treat the knee. The gel-like substance
lubricates the cartilage to help improve shock absorption, so the joint
can move more freely.
These methods don’t work for everyone—and sometimes patients report
relief after early injections, but no noticeable relief after follow-up
injections. There’s even evidence that people who take the shots may
benefit from the placebo effect.
A 2017 study found that people with knee arthritis reported the same
pain relief whether they received a steroid or saline shot. Plus, the
steroid group experienced additional cartilage damage from the shot
itself.
The American Academy of Orthopaedic Surgeons remains neutral on the
idea of injections. The bottom line, experts say, is that injections
have a place in the tool kit, but should not be considered a long-term
treatment option.
When Should You Consider Joint Replacement?
In many cases, nonsurgical treatment may bring the relief you need.
But in others, it may not. Even if you’re following all of these
strategies, joint replacement ultimately may be necessary, says Dr.
Sheth.
“When you start to limit your life for your joint, which means you’re
not doing specific activities of daily living because you’ll end up
with pain for the next several days, then it’s time to consider an
evaluation by a specialist and discuss the possibility of joint
replacement surgery,” he says.
Fortunately, if you’re healthy enough to undergo total joint
replacement, the current protocols for surgical technique,
post-operative rehabilitation, and pain control are so advanced that
most older adults return to a high level of functioning. Check out our guide to recovery after knee replacement surgery.
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