Hip and knee surgery is usually elective, meaning that it is not usually life-threatening (the exception would be for hip fractures). Most joint replacement surgeries are for patients who have had time to think about surgery carefully and are wellmotivated to do well with the surgery and participate in the rehabilitation afterwards.
It is common for patients to ask when they should have surgery for hip replacement, hip resurfacing, or knee replacement. Clearly, some conditions are urgent, such as a hip fracture or an impending fracture from a tumor, but the majority of patients are undergoing surgery primarily for pain relief, and secondarily to improve their function. Joint replacement is typically scheduled when the patient reports that the level of discomfort and impairment are such that they are willing to accept the risks of surgery to have it fixed.
As a general rule in our practice, if a patient is a candidate for an elective surgery (often either joint replacement or resurfacing), we have a long discussion with the patient about what the surgery involves, possible risks, possible alternatives, and what we hope to gain with the surgery. We usually recommend that the patient talk it over with family members, give it careful thought, and let us know if and when he or she would like to schedule elective surgery.
Take Family & Friends With You
It is often a good idea to take family members or friends along with you, particularly if they will be involved in the decision making process with you. Although it is certainly possible to have an excellent outcome without any additional help, most patients benefit greatly from the assistance of family or friends during and in the weeks after hospitalization. Moreover, the office visit is usually packed with a great deal of information from your doctor, and studies (and experience!) show that most people are unable to absorb all of it and often forget at least some details.
As mentioned earlier, another good reason to include family members or friends in the office visit is the Health Information Privacy Portability and Accountability Act (HIPPA) enacted by the federal government a few years ago. Although the law was intended to protect patients' privacy, it has had some unforeseen consequences over the past few years that have frustrated patients and healthcare providers alike. The law is quite strict about discussing patient care and information with anyone other than the patient without permission. I frequently receive telephone calls from patients' adult children or even spouses a week or two after their visit wanting to know what was discussed with the patient and details about surgery, and we are both frustrated that I cannot discuss these things with them. Additionally, when I receive their phone call days or weeks after I have sat down with the patient and discussed their surgery and plan in detail, I may not have all of that information right in front of me to answer those questions. Therefore it is best to bring all involved family members or friends to the office visit, and everyone's questions can be answered completely.
Can you wait too long?
Many patients ask if it is possible to wait too long to have the surgery. The answer to that is not simple, but the most important response is that the patient should have the surgery when he or she is good and ready for it. This includes being both physically and psychologically fit for the surgery. Conversely, some patients putting off surgery do go on to develop significant other medical problems (such as major cardiac issues) that subsequently prevent them from having the surgery, and they may wish they had had the surgery before their health deteriorated. But even so, I advise my patients not to proceed with surgery until they are comfortable with the decision to do so.
Most patients decide to have elective joint replacement when they find that they are significantly changing or limiting their daily activities in order to accommodate the disease. For many, this is primarily because of the pain, but other common reasons I hear from patients are inability to do the activities that they love (such as playing golf, tennis, going for walks, playing with grandchildren) or loss of independence.
Arthritis does not get better. If anything, the best that can be hoped for is a slow progression. Flare-ups of the symptoms may subside, but the times between flare-ups will gradually shorten, and the severity of the episodes will increase until it becomes a constant problem for most patients. Bones and muscles lose strength and mass (osteoporosis and muscle atrophy) when joints are severely arthritic, although significant muscle recovery is possible in the months after the joint is replaced.
Putting off surgery when arthritis is severe can have some detrimental effects as deformity increases (this is especially true for knee replacements) and muscles deteriorate, leading to a more difficult rehabilitation, or in some cases, limiting how strong they will ever be. This can limit the maximum range of motion that a patient may realize after surgery. Further destruction of the joint can make the surgeon's job somewhat more challenging as well. Lastly, I often advise patients that if they ever find themselves needing narcotics on a daily basis to get through the day, it is probably time to think about surgical intervention. Narcotics are best used for a short term problem, such as after a fracture or right after surgery, and serious problems can result with long term use.
Second Opinions
You should always keep in mind that there is never any harm in obtaining a second opinion. Some patients obtain a third, fourth, or more opinions before deciding on a surgeon and surgical procedure they are comfortable with. Few good orthopaedic surgeons will ever disagree with getting additional opinions prior to an elective procedure. However, you should probably provide your surgeon with records and office notes from prior opinions, so that he does not repeat any unnecessary workup and has all of your information prior to surgery.
In The End - Your Decision!
In short, this is not a decision that can be made for any patient. The surgeon's job is to evaluate whether or not the patient is a candidate for surgery and to present the patient's options to them. It is a decision that each patient must be comfortable with.
Although it is natural to have some anxiety before any major surgery, every patient needs to have a good understanding of what is involved and be satisfied that they have reached the point where they are willing to commit to the necessary hospitalization, rehabilitation, and potential risks. The best advice here is to take as much time as you need to make a good, informed choice.
Please remember the information on this site is for educational purposes only and should not be used to make a decision on a condition or a procedure. All decisions should be made in conjunction with your surgeon and your primary care provider.
