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Osteoarthritis and Joint Replacements: the Reactionary Water We Are Swimming In

Osteoarthritis is the most common form of arthritis and the most common cause of disability among aging adults. Approximately 32 million people are living with osteoarthritis within the US.

Largely, the way we have addressed the treatment and modulation of function among people with osteoarthritis, is to offer progressive surgical interventions, segueing into eventual joint replacements. As a medical society, we have subsumed a tertiary and reactive response to this chronic issue, rather than offering prevention, disease modification and education techniques.

Joints replacements are wonderful surgeries. They have come a very long way. The prosthetics and outcomes are better each year. And some people really need them.

And yet.

I witness every week people using joint replacement surgery as a primary intervention- which it should never be.

I might be hyperbolic when I write, but assigning someone with non-traumatic joint issues to a joint replacement before making a concerted effort in conservative care, is a bit like treating folks with hypertension with open heart surgery.

When I first started working in the field of Physical Therapy in 1995, we saw very few clients with joint replacements. We would see the occasional spinal fusion, more commonly after a debilitating work injury.

But many clients managed arthritic changes with conservative care: medications, exercise, manual therapy and modalities (such as ice, heat, TENS units).

I was in PT school from 2003-2006, and by the time I passed my boards and was treating in early 2007, a much larger stream of clients were entering the PT office I worked at as post- surgical total knee arthroplasty (TKA) patients.

During the last 14 years of clinical practice, that number keeps growing. One of the clinics I worked at went on to specialize solely in post joint replacement care.

Each year, the prevalence of joint replacements grows. The US census bureau has been monitoring numbers of patients receiving hip joint replacements between 2015-2020.

Last year, the census estimated over 600,000 people in the US underwent total hip arthroplasty (joint replacement) surgery.

The census projects the growth of people treated each year with joint replacements to grow by 110% by the year 2025- when 1.2 million people might go under the knife annually.

The decision to have surgery is a big event in everyone’s life. I am concerned when I hear patients approaching it in a flippant way – as though the replacement is not a big deal.

Each surgery is a really big deal.

There is a wonderful orthopedic surgeon in Seattle, Dr. Seth Leopold, who is working to change the conversation around orthopedic surgeries among surgeons, and help arthritis patients navigate the minefield of modern medical care. You can find his bio and links to his editorials here.

Most people know and understand the potential issues that can arise with surgery-from infection to pulmonary embolism.

But there are other unforeseen challenges. A joint replacement causes time out of work, down time at home, increased burden on partners or children who may assume the role of caregivers, not to mention the actual monetary cost of the surgeries.

A joint replacement is one of the very few surgeries that immediately and irrevocably changes a person's available biomechanics (joint replacements and fusions are the two orthopedic surgeries that result in permanent movement change). This has many implications throughout the rest of the person’s movement chain, and should not be taken lightly. When you change the ability of the knee joint to flex, you load and stress the ankle, hip and spine differently.

Just an MRI of the knee alone can cost upwards of $6,000. Joint replacement surgeries themselves cost around $15,000 on average. These fees may or may not include the anesthesiologist’s hefty (and worthy!) fees.

When you shift the focus back to a national issue, in 2020 we spent $9 billion dollars as a country, on hip joint replacements (not to mention knees!) alone. And we are on a fast track to spend a whole lot more.

The reasons behind why we have become dependent on this extremely invasive and permanent surgery to ameliorate our arthritis problems are both political and economic in nature- and really beyond the scope of my capacity to write about (or my interest to research).

What I am interested in exploring this month, is discussing how we as individuals can move from receivers of reactionary care to primary medicine participants in our own joint wellness.

A good approach to begin changing the arthritis problem we face will be threefold: education, prevention strategies and disease modification techniques.

We need to understand what arthritis is, what tissues are involved in its genesis and progression and alleviation, and why arthritic conditions don’t always explain our pain.

I also hope to address how to continue to work with your body in the event that you have already undergone a joint replacement.

So strap on your histology hats- for next week we will take a look into the magnificent tissue that is our hyaline cartilage- starting with education so that we may grow our own understanding and move into a higher level of health.

Happy (learning) and Moving!


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