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Massachusetts Medical Society's Physician Focus

May 2013

Joint Replacements


  • More than a million people are year are getting joint replacements, usually hips or knees.

  • Normal wear and tear, obesity, injuries, genetics, and conditions such as arthritis are major factors contributing to joint replacements.

  • To achieve the best outcomes, surgeons recommend patients undergo “prehabilitation” as well as rehabilitation.

  • With proper care and modification of activities, hip and knee replacements should last approximately 20 years.

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Exercising regularly, a good diet, and maintaining a proper weight are key steps medical experts recommend for good health and healthy aging. They're also a good prescription for healthy joints. But not enough of us are taking the advice.

Joint replacement has become a booming business in health care, with more than a million people getting new joints every year, usually hips or knees. And the numbers are expected to increase as baby boomers now approach their mid-sixties.

R. Scott Oliver, M.D., a board-certified orthopedic surgeon at Plymouth Bay Orthopedic Associates in Duxbury, Massachusetts who specializes in hip and knee replacement surgery, says the major reasons for the increasing number of joint replacements are the basic wear and tear on joints over many years, injuries, a genetic predisposition to weak joints, conditions such as osteoarthritis, and obesity.

Dr. Oliver, who is also Chief of Orthopedic Surgery at Jordan Hospital in Plymouth, Massachusetts, joined program host and primary care physician Bruce Karlin, M.D., on the May edition of Physician Focus with the Massachusetts Medical Society to discuss the various aspects of joint replacements.

Among the topics of conversation are why more people are getting joint replacements, how they are done, and what patients need to know before, during, and after surgery.

One of the biggest reasons for joint replacements, Dr. Oliver says, is the normal wear and tear of the joints over many years of use. “The cushioning between the bones – the cartilage or meniscus – simply wears out,” he says, “just like a tire tread. You then have bone against bone, and that means people with a lot of pain.”

Dr. Oliver says another factor contributing to joint problems and replacements also happens to be one of the nation’s biggest health concerns: obesity. Carrying too much weight wears down the joints faster because the body has to accommodate the extra pounds.

But he also says the excess weight, while a cause for surgery, presents a problem. “If you put a new knee joint in a person that’s too heavy,” he says, “the joint will last only a few years, and that’s not helping the patient.” In some cases patients will have to undergo weight-loss surgery before joint replacement surgery.

In preparing for joint replacement surgery, Dr. Oliver says “it’s best to be in great shape, make sure your weight is down, and if you have any history of heart disease, make sure you see a cardiologist before the surgery because the biggest stress on your heart is the surgery.” He says a good surgeon will send a patient to physical therapy for “prehabilitation,” to ensure that muscles are as strong as they can be and the body is ready for surgery.

Dr. Oliver stressed the critical importance of joint health and its connection to overall health. “Unless you have good hips and knees,” he says, “you can't exercise your heart and that heart has to be able to handle the stress of life. So it’s important to keep your skeleton going so you can keep your heart going.”

Replacing joints can relieve pain and make people active once again, but Dr. Oliver warns, a new artificial hip or knee isn't the same as the original and that modification of activity will be necessary. High-intensity activities, for example, like jogging or basketball, are inadvisable.

His advice to patients carries the thought that it’s perhaps best to do what we can to keep our body’s original parts: “It’s important that people know,” he says, “they have to get into good shape to get old.”

Watch the above program for the full discussion, including conversation on the first signs of bad hip or knee joints, elements of “first-level’ treatment for inflamed joints, descriptions and demonstrations on full and partial replacements with model hips and knees, and steps patients need to take for rehabilitation to achieve the best outcome after surgery.

MMS/Richard Gulla

American Academy of Orthopaedic Surgeons

Arthritis Foundation

Plymouth Bay Orthopedic Associates

Jordan Hospital, Plymouth, Mass.

American Joint Replacement Registry

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"Joint Replacements" PSA

From left, Bruce Karlin, M.D., R. Scott Oliver, M.D.
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