Karrey's story: Knowing when it's time for joint replacement can be the toughest part of surgery
- on July 12, 2011
Editor’s Note: Here's my firsthand account on joint replacement in a three-part series. Today: Preparation.
Seven years ago, I was training for a half marathon and injured my right hip to the point I could barely walk.
During the next two years, after consulting with a couple of doctors and physical therapists, I eventually was referred to Dr. Kelly Hendricks, an orthopedic specialist at Kansas University Hospital.
Sitting in an exam room, my husband and I nervously awaited the diagnosis.
Did I have a tumor? Would I need surgery? Was there a treatment?
The doctor took one look at my X-rays and said that I would need a hip replacement. And then came these two words: Stop running.
Gulp! That was a difficult pill to swallow for this lifelong runner. He said I could bicycle, swim or walk. But no more running.
Hendricks anticipated I would need the hip replacement within one to five years.
“You will know when you’re ready,” he said.
About 230,000 hips are replaced each year in the United States. Along with hips, other joint replacements include knees, shoulders, hands, elbows, fingers and ankles.
Knees are the most common with about 543,000 each year, followed by hips and then shoulders. Joint replacements are needed for a number of reasons. Among them:
• Osteoarthritis — wear and tear on the joint that causes loss of cartilage, which serves as the cushion between the bones. It’s the most common reason.
• Trauma — an accident that damages the joint.
• Systemic illnesses — such as rheumatoid arthritis and lupus.
• Congenital — A condition existing at birth. It’s probably the least common reason and the reason for mine.
I was born with bad hips. The fancy words for it are congenital hip dysplasia or developmental dysplasia of the hip, which means my joints didn’t develop correctly. This happens in about one of every 1,000 births. It’s more common in females and babies who are born breech, which I wasn’t. The degree of abnormality varies greatly.
Because I limped when I started walking, my parents took me to an orthopedic surgeon in Salina. My mother told me that the doctor tried traction, where my legs were suspended in the air, but that didn’t work. She said the doctor cried because he had put me through that.
Then, he performed surgery. He took bone from my tiny leg and formed the rest of my under-developed socket. I was then put in a frog-leg cast during recovery. Everything — appointments, traction, surgery, casts — happened before I reached age 3.
All I remember are a few annual check-up visits with the surgeon and having to wear ugly, brown orthopedic shoes until third grade. The shoes were to help keep me from being pigeon-toed.
Growing up, I was a typical, active kid who rode horses and played sports. The only reminder was a scar from the surgery.
I never had any problems until my early 30s when I started to have some pain in my joint. From there, it escalated.
Acknowledging when you’re ready for a joint replacement isn’t easy. For me, it was the toughest part.
Several orthopedic surgeons told me that joint replacement was an easy diagnosis to make. They can see the deterioration on an X-ray — often the cartilage between the bones is nearly gone. They also can tell by the lack of a patient’s range of motion.
Dr. Doug Stull, of OrthoKansas, said a patient’s options typically are:
• Do nothing and live with it. Take an over-the-counter pain medication and do the best you can.
• Get injections of Cortisone, a powerful anti-inflammatory medication, or Visco supplementation, a gel-like substance that enables bones to move smoothly over each other and as a shock absorber for joint loads.
• Get a joint replacement.
“To go from taking Tylenol, to go into the operating room for three hours ... it takes a lot of thinking to come to terms with that,” Stull said.
I’ve talked to several orthopedists and their advice is the same: Wait until you can’t tolerate the pain anymore or it keeps you from doing the things you like to do. Also, no two cases are alike.
When given those three options, more people are choosing to have joint replacement, and at younger ages.
The number of hip replacements is expected to grow 174 percent to 572,000 surgeries each year by 2030, according to a 2007 article published in the Journal of Bone and Joint Surgery. Knee replacements are projected to increase 673 percent to 3.4 million a year.
At OrthoKansas, the surgeons do almost as many hip and knee replacements for people in their 50s as they do for people in their 70s.
“People just want to be more active as they get older and they don’t want to sit and do nothing,” Dr. Richard Wendt said.
For me, loss of mobility and increased pain came slowly.
The pain subsided for a while because I stopped running. Then, it became harder to walk, to stand for long periods, and to get in and out of my car. My other muscles started to compensate for my weak hips. The pain was spreading to my lower back and down my legs.
There’s also a fine balance between doing too much and not enough when it comes to arthritis. It also can be painful to sit for a long period of time, for example, on an airplane or in a car.
In December, during my annual visit with my primary doctor, she said, “You really should think about getting the surgery. Think about how it’s affecting your daily life.”
She was right. My husband and I weren’t going on trips anymore. During our last trip to Las Vegas, it was painful just walking up and down the Strip. I didn’t like to go shopping anymore. Putting on my shoes was a challenge. The list goes on.
I made an appointment with Hendricks in March. He didn’t even have to ask. He knew I was ready. He also said my left hip was now as bad as my right.
I scheduled surgery for May 19, and decided to take a free class in April to learn about what to expect during surgery and recovery. As I listened to Andi Dohlman, orthopedic nurse coordinator, talk about using walkers and canes and depending on people to help with basic needs during recovery, a tear rolled down my cheek. I couldn’t believe this was happening. I am the person who takes care of others. I am the person who likes to go, go, go.
But at least there was a treatment, and for that I was grateful.
That’s another thing doctors agree on. For improving a person’s quality of life, joint replacement is one of the best surgeries ever developed.
Hendricks put it this way: “If you look at surgery and giving people back quality of life, hip replacement is always in the Top 5 and it’s pretty much No. 1 as far as impacting people’s lives long-term. Hip replacement is probably the best thing we’ve come up with in the 20th century.”
The most common joint replacements are knee and hip. At OrthoKansas in Lawrence, the surgeons performed 80 hip replacements and 211 knee replacements in 2010.
The national success rate — meaning improvement in pain and function without major complications — for both surgeries is between 95 and 98 percent.
The length of surgery and recovery depend on each patient.
• About 230,000 performed each year in the U.S.
• Expected to grow 174 percent to 572,000 surgeries a year in U.S. by 2030.
• Developed in 1960s.
• Surgery consists of replacing both the acetabulum and the femoral head.
• Famous people who’ve had them: golfer Jack Nicklaus, musicians Billy Joel and Eddie Van Halen, Duke University basketball coach Mike Krzyzewski and former Olympic gymnast Mary Lou Retton.
• About 543,000 performed each year in U.S.
• Expected to grow 673 percent to 3.4 million a year in U.S. by 2030.
• Developed in 1970s.
• Surgery consists of replacing the diseased or damaged joint surfaces of the knee.
• Famous people who’ve had them: actors George Hamilton and Michael Douglas, and tennis player Billie Jean King.
LIVE ONLINE CHAT
Dr. Doug Stull, an orthopedic surgeon at OrthoKansas, will participate in a live chat at 1 p.m. Monday on WellCommons.com. He can answer questions about orthopedics, which involves the care of bones and joints.
Typical problems include fractures; dislocations; strains of muscles, ligaments and joints; tendonitis; bursitis; and arthritis.
OrthoKansas performs arthroscopic surgery; total joint replacement of hips, knees and shoulders; shoulder reconstruction; complex hand surgery; and other procedures.
Stull specializes in the treatment of the shoulder and elbow in all ages and aspects including sports, trauma and reconstruction.
You can submit a question on WellCommons.com, and then check back to see if your question is answered.