July 11, 2023 – Kathy Blackwell won't let just a few sore joints stop her from living her best life.
The 73-year-old resident of Simi Valley, a housing community about 30 miles northwest of downtown Los Angeles, organizes regular activities for her senior group. The 20 to 30-member group of experienced residents, mostly women, stays lively. In the approaching weeks, they plan to fulfill the Beach Boys on the historic Hollywood Bowl and take a cruise to Alaska.
Because of her busy schedule, Blackwell plans to postpone her second hip substitute surgery and as a substitute go for a cortisone shot in hopes of relieving the pain enough for her to benefit from the trips ahead.
Not that she's afraid of a joint substitute. If her orthopedist offered a daily customer punch card just like the ones you get on the local coffee shop, her card could be almost full. Blackwell's knee and one hip were replaced, and her other hip can even get replaced once her calendar clears.
“If you go on with chronic pain long enough and don't feel any relief, you start to get grumpy,” Blackwell said.
More than 1 million recent knees and hips
Joint replacements have gotten increasingly common, with roughly 790,000 total knee replacements and greater than 450,000 Hip substitute performed annually within the United States, according to the American College of Rheumatology.
Experts agree that age doesn't play a job in choosing candidates for joint substitute. Rafael Sierra, MD, of the Mayo Clinic, said he has performed hip replacements on patients ages 12 and 102. Orthopedic surgeon John Wang, MD, of the Hospital for Special Surgery in New York City performed total knee arthroscopy on a patient in his mid-90s. At 73, Blackwell is on the older side of the world The average age for a hip replacement is 66 years.
“Many research and studies have shown that regardless of age group, people end up doing well,” Wang said.
Even more essential than age is that older patients are prepared for postoperative therapy and treatment. For younger patientsthe largest drawback is survival the estimated 25-year lifespan of a joint replacement. Complications are rare and do occur in about 2% of procedures. These include infections, joint dislocations and blood clots; Other health problems that you furthermore mght have don't matter.
Given the difficult time Blackwell had along with her first knee substitute, it's no wonder she ever set foot in a surgeon's office again.
After putting it off for seven years, Blackwell finally agreed to her doctor's advice to switch her left knee in 2017 to alleviate what she called “crunching,” chronic bone-on-bone pain.
“It got to the point where there were no alternatives,” she said.
But her first orthopedic surgeon did a “poor job” and left her with a gaping, festering wound that led to and required sepsis Wound vacuum therapy to shut the lesion. She eventually found one other surgeon who removed and cleaned her artificial knee before replacing the prosthesis. Luckily, the sepsis didn't spread and eight surgeries later she was healthy again.
Blackwell's second knee substitute in 2018 was a picture-perfect operation, as was a hip substitute in late 2019.
“Your whole attitude changes,” she said.
What generalists should know
Orthopedists recommend primary care physicians ask two things when considering joint substitute: Have non-surgical treatment options been exhausted and is the pain unbearable? They also recommend avoiding narcotics to treat symptoms.
The most vital query a primary care physician should consider when considering whether their patient is a candidate for joint substitute is whether or not the pain and imaging is severe enough to warrant surgery.
“You don’t want to do it too soon,” Sierra said.
Sierra likes to inform the story of the golfer whose knee went stiff after 18 holes. He recommends that these patients reduce activity; on this case, using a cart or playing only nine holes.
Wang agrees, asking whether the pain is “lifestyle-altering” and whether the patient has not responded to non-surgical treatments comparable to over-the-counter medications, anti-inflammatory drugs and injections, home exercises or physical therapy, and whether he has worn a brace or sleeve. or just change their activity.
And no addictive painkillers to treat arthritis, which may result in other serious problems.
“This won’t heal itself,” Wang said. “It won’t get better on its own. So we don’t want to throw narcotics at it just to cover it up.”
Karen Smith, MD, has been a family physician in rural North Carolina for greater than 30 years. When she sees patients complaining about their joints, she first looks at function and pain. From there, she explores why they feel uncomfortable. For example, is the issue an ergonomic issue at work or the results of carrying plenty of body weight?
“We are looking at these areas to see what can be changed,” she said. “All of this is done before the orthopedic procedure takes place.”
Smith said she also considers things beyond basic medicine: What is the patient's psychological status and pain tolerance? Is there a post-operative care support system at home? And can they afford to miss work?
“We look at all of these factors together because they determine the outcome we want to achieve,” Smith said.
Great expectations
A recent study shows that older patients respond higher to knee replacements than younger patients, particularly by way of pain relief and quality of life. It is believed that the rationale for this lies in expectations. While a younger person will probably want to return to the racquetball court and perform as usual, older patients may simply wish to walk down the hall without discomfort.
“It's possible that these under-55 patients simply need a little longer to heal and be satisfied,” Wang said. “We really can't say why this is, but it is possible that the younger patients are more active and expect more from their knee.”
Jeevan Sall, MD, is a primary care sports medicine physician at Providence Mission Heritage Medical Group in Laguna Niguel, California. First, he discusses the conservative treatment of patients that suffer from arthritis of their joints. These measures include rehabilitation exercises, braces, shoe inserts, medications, and weight reduction measures. If these steps don't improve a patient's pain or lifestyle, surgery is on the table. Managing expectations is an important factor.
“Is the patient mentally ready for surgery?” Sall said. “This includes what they want to achieve with the surgery, as well as the risks and benefits of the procedure.”
Blackwell's hip and knee pain were simply the results of a well-lived life that included no marathons or significant life-altering accidents. She worked as a homemaker, raised her two children and owned an elevator company along with her late husband Robert Blackwell.
Yes, there are jokes within the elevator construction industry.
“We have our ups and downs,” Blackwell said.
And along with her recent joints, Kathy too.