Richard, a 65-year-old man, met with me earlier this week confronted with one of the most challenging decisions my patients face. He is a healthy and active man. He has always exercised regularly and his good diet has kept him trim. But Richard has not been feeling so youthful lately.

Despite taking pain medications daily and having been through a course of physical therapy, Richard’s right hip is painful almost all of the time. He recounted to me how it wakes him at night and how the ache runs almost all the way down his hip. In the morning or when the weather changes, the pain becomes excruciating. When he tries to get up from his chair, Richard’s hip locks, and sometimes he can’t even get out of his car.

Last summer, Richard ran in the Yarmouth Clam Festival race. He loves to paddle his kayak on the ocean. Now that his grandchildren are older, he takes them biking. But this summer has been very different. Richard has not been able to do any of his favorite activities, all because of his painful hip.

After telling himself for months it wasn’t really serious, Richard finally went to see his family doctor about the pain. Through his doctor, he made his way to me. The X-rays we did showed no surprises — Richard had almost no cartilage left in his hip. He had advanced arthritis.

Many patients suffer for years with arthritis pain. By the time they come to my office, they have often given up activities they love, like that Sunday golf game or caring for their flower garden. Getting around becomes so uncomfortable that they are often reluctant to walk even the shortest distances. One patient recently confided to me that she was using her mother’s walker around the house. Even getting from the living room to the kitchen had become excruciating for her.

But despite this level of pain, many patients like Richard delay the decision to have a joint replaced. They are fearful of having such an extensive operation. They worry about the recovery and wonder if they will ever regain the function they had before the procedure.

As we discuss their reservations, a number of patients recount a negative experience one of their parents had with a joint replacement.

Most of these patients don’t realize that delaying a joint replacement can actually harm their chances of recovery. The success of the operation is only partially in the hands of the surgeon. The rest relies on the patient’s ability to do good rehabilitation — to make the joint strong again. As patients like Richard delay taking care of their joints, they become more sedentary and weaker, making good rehab that much harder to do.

So what’s the key to having a good outcome with a joint replacement? Patients should work with their doctors to keep strong and active. Once the arthritis advances to the point that they experience pain all the time, it is best to begin discussions about joint replacement.

Patients should work with their doctors to begin doing exercises before having surgery — we call that prehab — so their muscles are as strong as possible. And finally, patients should not be fearful of taking pain medications.

In my office, we use all the tools we can to keep our arthritis patients strong and active, whether or not they’re ready for a new joint.

Richard and I had a good conversation about replacing his hip. I let him know that most patients wake up from the surgery pain-free for the first time in years. He asked great questions about what he can expect, both during the procedure and afterward.

He’s working on his prehab today, and he is scheduled to see a surgeon next week. For Richard, a new hip will represent freedom from the pain and a chance to get back to the activities he loves the most.

 

Dr. James Glazer is a sports medicine physician for Coastal Orthopedics and Sports Medicine in Freeport. He serves as a consultant for the Portland Pirates and the U.S. ski team.