Time for a Joint Replacement?

How to know when the time is right for this major surgery

Getting around campus again

Severe arthritis made walking nearly impossible for Kutztown University professor Claire Van Ens. In her case, it clearly was time for knee and hip replacements.

When Claire Van Ens of Kutztown went to see orthopedic surgeon Paul Pollice, M.D., of Lehigh Valley Hospital and Health Network in 2004, she expected to schedule arthroscopic surgery on her painful knees. After all, other surgeons had done this mini-surgery three times on one of her knees and twice on the other.

Then Pollice showed her the X-rays. There was no cartilage left in either of the 52-year-old Kutztown University professor’s knees, leaving bone to rub painfully against bone. With such advanced arthritis, Van Ens was a candidate for total knee replacement. But the decision was up to her.

“The pain was terrible, but even then I would have waited if it hadn’t impaired my lifestyle,” she says. “I couldn’t stand up to teach classes or walk down the halls, and I had to stop walking my dogs.” Van Ens had both knees replaced and a year later both hips, when they deteriorated the same way. Now, she’s regained her active life.

How severe is my arthritis? That’s the first question for Van Ens and anyone else contemplating joint replacement. Pain is one clue; another is the extent of cartilage loss revealed in X-rays. Treatment begins with medication and physical therapy, Pollice says. “If we can’t manage the pain with those approaches, it’s time to begin considering surgery.”

Joint replacement relieves 95-100 percent of the pain and “gives people back their life,” Pollice says, but it’s still not something to rush into. This is major surgery requiring several weeks of rehabilitation. And regardless of the patient’s lifestyle, artificial joints wear out after 10-15 years even with today’s longer-lasting materials. That means people in their 40s or 50s may need two or more total or partial replacements in their lifetime. “After the first one, surgery is more complex,” Pollice says. “As an artificial joint wears out, it may weaken the supporting bone, making bone grafts necessary.”

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