Our bodies are like machines: As you start climbing the hill to age 50—and going over it—your parts starts to wear down. Eventually, they may require tune-ups or replacements. Your knees and hips are particularly susceptible to wearing down over time, since they bear much of your body weight. When this happens, you can either use painkillers and cortisone shots to manage discomfort and buy time—or you can choose to go in to discuss a repair or replacement part.
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Joint Health Assessment Test
Charles Nelson, MD, Chief of Joint Replacement Service at the Penn Musculoskeletal Center, discusses chronic knee and hip pain for individuals over 50 years of age and whether joint replacement is their only option.
What percentage of your patients for joint surgery is over age 50?
Dr. Nelson: I suspect that around 65 percent are over the age of 50. There is no doubt that the patients under 50 are increasing, though. That’s just not in our practice: There are trends all over the country that demonstrate an increase in joint replacement in patients under 50.
For your patients over 50, how does knee and hip pain affect their quality of life?
Dr. Nelson: It depends on the severity. In some extreme cases, we see patients that can’t walk at all.
They may be completely limited to the point where they have a chair lift that takes them up and down the stairs, and they get wheeled around in either a manual or motorized wheelchair. So, instead of going to church, they may listen to a service on Sunday on the television or radio and not socialize or attend activities they used to. People will cut activities out of their lives just because they fear the pain they may experience during or following the activity.
Is joint replacement the first thing you recommend for people over 50?
Dr. Nelson: I think knee or hip replacement is a personal decision for the patient. It depends upon the circumstances and where the disease is. In some cases, the arthritis is localized to a single area of the knee or hip, meaning that a partial joint replacement may be more appropriate. There are a number of different injuries and other soft tissue conditions, some of which can get better on their own or with physical therapy. Others that don’t get better on their own require knee or hip repairs. One common procedure is arthroscopic surgery, where a small camera is used to identify and treat the damaged area.
If they’re younger and have good surrounding cartilage with a specific defect in the knee or hip, then sometimes you can repair that defect with cartilage cells from the person. This is called a cartilage transplantation. Or you could repair the area with fibrocartilage from their own bone marrow. But again, it is a complex scenario because it’s really based upon the specific issues related to that individual patient.
What are some non-surgical alternatives to knee replacement?
Dr. Nelson: They can put less pressure on their joints. That can involve weight loss if they are overweight or it can involve the use of a cane, crutches or walker.
They can offload their knee with a brace. They can also take anti-inflammatory or analgesic medications to decrease their pain. They can do injections of either an anti-inflammatory medicine like a corticosteroid or they can undergo a joint lubricant injection.
What’s important to understand when evaluating these options?
Dr. Nelson: I think it’s important to have realistic expectations. I would encourage people to speak to others who have been through that type of intervention to see whether that’s something that makes sense for them. I think trying to get as much information as possible from other patients who have been through it can be very helpful. And if it’s someone they are close to and have a bond with and trust, all the better.