AAMC Magazine

Spring 2006

A candid conversation with Marshall Steele, M.D.

Medical Director for the AAMC Joint Replacement Center.

When is it time to consider surgery?
The standard answer to that question for years has been “Wait until you can’t stand it anymore,” but that response is beginning to change a little. First of all, that answer leaves patients uncertain. What one person can stand may be intolerable for another, so the answer is ambiguous.

Second, what about your quality of life? Yes, you can put surgery off, but what if you’ve had to discontinue an activity that is important to your quality of life? Is that a concession you’re willing to make? And there’s a subtle effect that “unseen” pain—like arthritic joints— can have on relationships. The person suffering is likely to be more stressed and difficult to live with, and the spouse and family over time, may grow weary of complaints and appear unsympathetic. You don’t want to wait until your spouse is ready to kick you out before you decide to undergo surgery. Third, recent studies indicate that people who wait too long don’t have as good an outcome. For instance, they may have given up exercise because of the pain, and as a result, they’ve gained weight, their blood pressure is up and their joints are now frozen. This is not conducive to a quick recovery and an excellent outcome.

When should I make an appointment with a doctor?
When you start suffering from what you think might be arthritis, you should address it immediately. The problem might be something more acute that requires immediate treatment. There are many non-surgical treatments available to keep you moving, active, and enjoying life. Patients should understand that Steps 1–9 of “The Top Ten Things to Do for Arthritis” are all non-surgical treatments they should try before they consider surgery [see sidebar]. I also insist that my patients visit a physical therapist to ensure that the exercises they are doing are helping, not hurting. The proper exercises also get patients in shape if surgery is necessary.

Hip and knee replacements are being performed on younger and younger patients because technical advances and improvements in the bearing surfaces help the replaced joints last longer. Less invasive surgery makes recovery quicker. Almost half the replacement patients are now younger than 65. Ten years ago, that wasn’t the case.

When non-operative care is no longer helping you sufficiently, see a surgeon who specializes in total joint replacements. Surgery is still the last option, but an excellent one for the appropriate patient.

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