Mount Auburn Healthcare Connection

Learn More:

• Related Links
• Quiz

Do you find your joints are a bit stiff when you get out of bed in the morning? Maybe your knee or hip joints ache when you walk around the block or kneel in your garden. When are these aches and pains just part of normal aging and when do they warrant medical attention?

James Phillips, M.D., orthopedic surgeon at Mount Auburn Hospital, a teaching hospital of Harvard Medical School, says, “If your quality of life is being affected, then it is time for you to see a physician. You should keep in mind that there are a variety of treatment options, besides surgery, that may be very effective.”

One of the primary causes of hip or knee pain is osteoarthritis, a condition where the joints start to experience wear and tear. Arthritis can progress very slowly and take months or years to get to the point where medical intervention is necessary. Osteoarthritis can be due to a number of factors, including a genetic predisposition, previous activity in high intensity sports that may have abused the joints, general overuse, and obesity, which may put too much pressure on the joints.

Most people see a physician for hip or knee pain when pain is interfering with their daily activities. If you are having knee pain, you may find it difficult to go up and down steps. If your problem is with your hips, you may find it difficult to sit for extended periods of time or to perform activities such as putting on your shoes or socks. People have different thresholds of pain tolerance. What is life-disrupting pain for some people may be relatively minor for others.

Many times a family practitioner may diagnose your condition and refer you to an orthopedic surgeon who will first take a complete medical history and perform a physical exam. A diagnosis of arthritis or some other condition causing joint pain is often confirmed through x-rays or medical resonance imaging.

Dr. Phillips says that his initial approach in treating a patient with hip or knee pain is usually not surgery. He typically recommends lifestyle modifications, physical therapy, anti-inflammatory medications (such as aspirin) or, in some situations, cortisone injections. Reducing the activity that is causing the pain may be helpful. If these treatment approaches do not sufficiently ease the pain, then minimally invasive surgery might be the next step.

Before surgery, patients have a complete “work-up” to make sure they are in shape for surgery and to minimize the possibility of complications. This may include blood work, x-rays, an EKG to evaluate the condition of the heart, and an examination by the patient’s primary care physician.

Many advances have been made in hip and knee replacement surgery in recent years. Frequently, less invasive or minimally invasive techniques are used, which result in quicker recoveries and less discomfort. Bearing surfaces used in hip and knee replacements are longer lasting than they used to be. Plus, surgeons are moving away from cement in hip and knee replacements. Instead, they use new materials that allow the bone to grow into them, resulting in better fixation and durability of the new joints.

While the term, “minimally invasive,” can be applied to a variety of procedures, it generally means a smaller incision and less tissue affected. For example, during a hip replacement, if there is one incision, it is usually less than six inches long. In some procedures, to minimize muscle damage, there are two incisions of approximately two to three inches each. During a hip replacement procedure, the damaged ball and socket are removed and replaced with a metal hip stem that goes down the shaft of the femur. The metal implant has a ball on top, much like the ball that was removed. The socket of the joint is cleaned out and then a metal cup, usually with a polyethylene bearing surface, is attached to the pelvis. The new metal ball rotates around smoothly inside of the plastic socket.

A minimally invasive replacement procedure takes an average of one to two hours. Many times, the pain the patient has been experiencing is immediately relieved after surgery. Physical therapy is an important part of the recovery process for both hip and knee replacement surgery and is usually initiated the day after surgery. Most patients can resume their normal activities in two to three months or less, particularly if they have had hip replacement surgery, which usually has a shorter recovery period than a knee replacement. While many patients can go back to sports activities, such as golf or tennis, participation in impact sports is not usually advisable because this kind of activity may decrease the longevity of the implant.

Joint replacements today are lasting longer than ever before. Knee replacements typically last at least 15 years while hip replacements may last 20-30 years, which for many patients may be their remaining lifetime.

Dr. Phillips says, “If you have hip or knee pain that is disrupting your life, you should see your doctor who will probably first recommend a number of treatments besides surgery; however, if you do eventually need to have a minimally invasive hip or knee replacement, these procedures offer patients many advantages, including decreased pain, the potential for greatly improved function, and a faster recovery.”