A Clarification on expectations for surgery

[Guest guest]

I think it's time to clarify some points about joint replacement surgery because

there seems a great deal of misunderstanding about what can be expected and what

may NOT be expected.

1. " I thought I would walk normally but now I think I never will "

Although only one or two people have posted about that here, this is a common

complaint.

To clarify, surgery is NOT to restore full function or to " walk normally " . As I

understand it from the medical providers, joint replacement surgery is PRIMARILY

to reduce the pain a patient may be suffering and hopefully to give them more

mobility than they had before surgery.

IF a patient can walk normally or more normally after surgery, if they can do

athletic things etc, that is a bonus but going into surgery, people should NOT

expect this because first of all, rehab is EXCRUTIATINGLY painful and MOST folks

will NOT be able to rehab (money-wise and pain-wise) the length of time (try a

YEAR or more) it might take to restore " normal " or near normal function.

Secondly, it just doesn't happen to some people. For one reason or another.

Third, I do know an athlete who had hip replacements and IS functioning above

normally (Rudy Galindo) but I suspect this is the exception not the rule. And

we all know that athletes work very hard and don't mind " sucking up " the pain

involved....

The idea of this surgery is to enable more mobility with a lot less pain.

2. LONG TERM. Joint replacement surgery is said to last for 10-15 years. It may

or may not last that long. When it wears out, the pain is back and sometimes

worse.

And the second joint replacement (or third... I know a guy who had 4 of them and

from the second on, he had serious problems and developed an immunity disorder

from rejecting the second - was on his back for 6 months) may or may NOT go in

as easily as the first.

SO, consider you might be buying some years of less or no pain and mobility but

that eventually, you might have the same problems again and be facing either

more surgery or serious pain.

We have a family member who is a medical provider who specializes in pain

management. I once asked him what were the most prevailent reasons patients

came to him. His answer was rather surprising. He answered " Surgery " I asked

what kind of surgery and he said " either back surgery or joint replacement

surgery " .

He went on to explain that these surgeries were done TO REDUCE pain but often

ended up causing as much or more pain and this is what I think, is

experiencing. (I applaud her for having the courage to post here and I do NOT

think people should assume she has some kind of " other problem " which is causing

or making her pain worse - people like her are more common than you think).

3. " I must have a joint replacement. The doctor told me my joint is going bone

on bone "

I hear this one ALL the time and this is what my mother was told to make her

feel that joint replacement was NOT elective.

Don't you believe it. It IS elective surgery. You don't have to have it.

, the fitness guru, mentioned in a recent letter that 20 years

ago, he had had surgery to " clean out all the cartilege " in his knee and had

been operating " bone on bone " for 20 years. As you can see, he walks normally,

etc and only has to ice his joints for 15-20 minutes daily. He is very fit and

obviously is keeping his knee in place with muscles - he does aerobics daily and

for 1-2 hours and not everyone has the time or is willing to do that. (He may

also be on pain management... I'm sure he would not tell that to the man/woman

on the street).

But I also know another lady who elected to NOT have joint replacement. Other

than using a walker, she lives normally and gets around well also...cooks large

meals, travels all over, takes cruises... pretty good for a 73 year old and

especially one who is extremely obese (BMI in the 50's!).

I know a 95 year old who elected to not have joint replacement. She walks slowly

with a walker and is stiff but still cooks and does stuff on her feet... and we

must admit that MOST 90 year olds are significantly LESS mobile than younger

folks.

4. Which leads into another misconception I've seen over and over. Joint

replacement is NOT made necessary by obesity! The population which MOST OFTEN

has joint replacement is the population of RUNNERS, particularly marathon

runners in their 40's... people in " perfect shape " .

As for osteoarthritis, it runs in families (has been observed since the time of

the cave men who were NOT obese and died when they were in their 30's and STILL

had arthritis!!). For example, my 16 year old granddaughter who has never been

overweight in her life (runs on the slim side) was diagnosed with osteo

arthritis when she was 13 years old! I came down with it when I was 9. And

about the worst case I know of, is in his 50's and underweight... extremely

underweight.

I have osteo arthritis and might face a decision about whether to have joint

replacement or not in the future (I am 63 years old and like am

very fit... have been working out for 14 years straight but unlike , I am

quite overweight). I don't know what I would choose but it would be a difficult

decision. I guess it might depend upon WHEN I needed it and how disabled I was

and how much pain I was suffering.

I don't want this message to be all negative. Joint replacement surgery is a

wonderful innovation. It has improved a lot since my mother had a hip

replacement (ended up with one leg longer than the other) and a knee replacement

- gave her about 7 years of good mobility and after that she was back to the

wheelchair. She also developed an infection in her hip joint which was a bother

and had to be surgically cleaned out.

I have seen some marvelous results with joint replacement... Rudy Galindo is

one... he's ICE SKATING!!! I know a lady at church who went from totally

hobbling to walking fairly well after she had 2 knee replacements.

But I'm just saying all this as a caveat. No one says how long the good effects

will last - probably differs from patient to patient and I suspect how much a

person exercises which may nor may NOT be comfortable and lots of other factors.

Different bodies react differently.

I know there are a lot of good results on this list. But I also know that one

never sees the whole story on TV or an internet list and chances are those who

ARE having problems may get discouraged thinking they are the only ones or

depressed at the suggestion that they have some psychological issues... pain

tends to be depressing. A surgical result which is not what someone was led to

expect, can be very depressing ... that is called " reactive depression " and IS

NOT per se, a psychological problem.

To and others who may have a similar result... the advantage with joint

replacement is that if it hasn't turned out " right " it's A LOT more fixable than

other types of surgeries. I would not necessarily say it was the surgeon's

fault but rather the old " doo doo occurs " thing and I WOULD seek a surgeon's

advice (or several). I think you would be pleased that perhaps with another

surgery, things may turn out totally different from what they are now. Please DO

NOT LOSE HOPE.

This is one of the most advanced type of procedures available in medicine and

they can do wonderful things....

SueW, moderator