Don’t Let Hip and Knee Pain Hold You Back

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By Cynthia Kahlenberg, MD, MPH

A recent report from the CDC found that one in four Americans — more than 58 million — suffer hip or knee pain, most commonly caused by arthritis. The report also found that nearly half (44 percent) of those with these conditions can no longer participate in daily exercise, hobbies or housework.

Fortunately, significant advances in recent years have helped doctors better understand and treat joint pain. These treatments help patients improve their mobility and get their former lives back.

As a surgeon at HSS Orthopedics with Stamford Health, specializing in hip and knee replacement, I often see patients bothered for weeks or months by persistent hip or knee pain. We are seeing a sharp increase in hip and knee issues. Years ago, many patients, as they aged, accepted a slower lifestyle and reduced activities. I now have many patients in their 40s-60s who are eager to resolve their joint pain and return to healthy exercise and daily activities.

Causes of Joint Pain

Some hip and knee problems can be hereditary. There’s a vital genetic component to osteoarthritis, the most common form of arthritis. Patients often tell me their parents or siblings had joint replacement surgery. General wear and tear over time can also reduce cartilage in a patient’s joints, causing pain and leading to arthritis.

Past injuries to the hip or knee can increase the risk for arthritis. Sports injuries such as a prior ACL or meniscus tear, whether it was fixed or not, increase the chances for arthritis years later. The same is true when someone has experienced joint trauma, say a hip injury from a car accident years before. Developmental conditions such as hip dysplasia can also increase the chances of arthritis later in life.

Treatment Options

I always try to manage hip or knee pain with conservative treatment before turning to surgery. This can include activity modification to avoid activities that can cause pain. Physical therapy can be helpful in early-stage arthritis to help strengthen muscles and increase flexibility. Maintaining a healthy weight is important to lessen the extra burden on joints that can cause joint pain. Steroid injections into joints can help reduce pain and inflammation.

When Surgery Makes Sense

There are three main factors for patients to consider with hip or knee replacement surgery:
1. The patient has tried all conservative treatment measures but is still experiencing pain.
2. The patient has bone-on-bone arthritis in the affected joint, which shows up in the x-ray.
3. Their pain level severely limits their ability to be mobile and enjoy daily activities.

Joint replacement surgery is an elective procedure. It comes down to patients realizing that when pain severely limits their mobility and prevents them from enjoying their favorite pursuits, it’s time to consider surgery.

The stigma about hip or knee replacement as just for older people is less prevalent today and more patients are opting for surgeries earlier. In fact, the fastest-growing demographic for replacement surgeries is the 45-64 age group. Many want to stay active and won’t accept a sedentary lifestyle.

Advances in Joint Replacement

The components we use in joint replacement surgery are now better than past materials. We use highly cross-linked polyethylene providing greater durability and less wear. These new materials help hip replacement patients recover faster, be active and gain greater longevity from their new hip. For many, joint replacement surgery lasts a lifetime.

At HSS, we use several brands of robotic devices and computer navigation technologies to assist surgeons in planning and execution. These technologies help increase the precision of implant placement and alignment. For hip surgery, this precision helps reduce the dislocation rate, which is a complication that can occur after surgery. These capabilities help improve patient satisfaction and function after surgery. HSS performs more hip and knee replacements than any other hospital in the country.

We’re involved with many cutting-edge studies to improve patient outcomes. I am working with a team of HSS hip and knee surgeons and our biomechanics department to run computer simulations of hip and knee replacement. These models help us determine individualized patient targets for ligament tensioning and balancing precisely for knee replacement. Our robotic and computer navigation technologies allow us to execute surgical plans and target specific alignment and balance of the knee with great precision.

Road to Recovery

We’ve made great strides in speeding up patient recovery from joint replacement surgery. Also, new surgical techniques and the use of regional anesthesia instead of general anesthesia lowers the risk of complications and side effects. We like to get patients up and moving right after surgery; most can go home the same day or after a one-night stay. Within six weeks, many patients can return to low-impact activities, then higher-impact pursuits soon after that.

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Cynthia Kahlenberg, MD, MPH, is an orthopedic surgeon specializing in hip and knee replacement at HSS Orthopedics with Stamford Health.

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