Is knee or hip replacement surgery for you?

Original article at
Written by Dr. Paul Mackarey / First of three parts

Probably no one looks forward to hip or knee replacement. But there’s good news in that recent advances have ushered in a new era of joint replacement for patients in Northeast Pennsylvania.

Hip and knee replacement surgery has had a positive effect on lifestyle and overall health for more than 7 million people in the United States — a number expected to increase substantially with the aging baby boomer population.

We’ll dedicate the next three weeks to hip and knee replacement. Today will focus on hip and knee arthritis and treatment options, including knee replacement. Part 2 will cover a self-assessment to help you determine if you’re ready or eligible for a new hip or knee.

And Part 3 will present the benefits and complications of a new hip or knee, specially looking at a new option: Mako Robotic-Arm Assisted joint replacement.

Hip/knee arthritis

I have been advising my patients to exercise, keep active and walk as long as they can in order to stay mobile and healthy. However, seniors often tell me activities that require prolonged walking are limited by hip or knee pain from arthritis. But these conditions need not sentence you to an inactive lifestyle.

The three most common forms of arthritis of the hip or knee are: Osteoarthritis, also known as degenerative arthritis, is the most common form. It is usually a slow and progressive process of “wear and tear” to the cartilage in the joint, which eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight-bearing joints such as the hip, knee and ankle.

Rheumatoid arthritis is a form of inflammatory arthritis that can affect many joints of the body. It is very destructive to the cartilage, joint and tissues surrounding the joint, can occur at any age and often affects both legs.

Post-traumatic arthritis can occur after a trauma or injury to the hip or knee. It is a form of osteoarthritis that is triggered years after a fracture, ligament or cartilage injury.

Symptoms of arthritis

Pain usually occurs gradually. However, a sudden onset can occur, especially associated with a sudden twist or fall. Pain is often worse in the morning and improves with movement. Changes in the weather or barometric pressure can cause pain associated with arthritis.

Swelling can occur after increased activity at the end of the day. Stiffness is more noticeable in the morning and improves with movement. But overuse can create more pain and swelling and lead to stiffness, too.

Weakness from disuse associated with pain can lead to occasional buckling of the hip or knee when walking or climbing steps. Loss of function is associated with pain, swelling, weakness and stiffness that limits walking, stair climbing and other activities.


Your family physician will examine your knee to determine if you have arthritis. In more advanced cases you may be referred to an orthopedic surgeon or rheumatologist for further examination and treatment. X-rays will show if the joint space between the bones is getting narrow from wear-and-tear arthritis. If rheumatoid arthritis is suspected, blood tests and an MRI may be ordered. The diagnosis will determine if your problem is mild, moderate or severe.


In the early stages, your treatment will be conservative and nonsurgical, which may include anti-inflammatory medication, orthopedic physical therapy, exercise, activity modifications, supplements or bracing. You and your family physician, orthopedic surgeon or rheumatologist will decide which choices are best.

Dr. John J. Mercuri, an orthopedic surgeon at Geisinger Orthopaedics & Sports Medicine in Scranton, recommends the following clinical practice guidelines from the American Academy of Orthopedic Surgeons.

First-line conservative treatment

Nonsteroidal anti-inflammatory drugs(NSAIDs) to reduce pain and swelling in the joint. These include ibuprofen, naproxen, diclofenac, meloxicam and celecoxib, but not aspirin, which is an anti-platelet medication. Tylenol is recommended for those who cannot tolerate NSAIDs.

Physical therapy: Heat, cold, ultrasound, electrical stimulation, joint mobilization/manual therapy, range-of-motion exercises, strengthening exercises and partial weight-bearing aerobic exercises.

Weight loss: Eat well and exercise.

Activity modification: For example, doubles tennis instead of singles; sitting or lying leg exercises instead of standing; walk/bike instead of run; soft-bed treadmill instead of hard surfaces; avoid squatting, kneeling and bending.

Assistive devices, such as a cane.

More aggressive but still conservative treatment includes intra-articular corticosteroid injections and tramadol, a pain medication.

Some interventions are not supported in medical literature, even though they are often used and may not be harmful. These include visco-supplementation; shoe lifts or wedges; hard or soft bracing; glucosamine and chondroitin; stem cells; opiate medications; acupuncture; and platelet rich plasma (though a recent study suggests there might be some benefit from PRP for knee arthritis).

Surgical treatment

When conservative measures no longer succeed in controlling pain and deformity or improving strength and function, more aggressive treatment may be necessary:

Osteotomy surgery: Cuts one of the knee bones to realign the joint for less wear and tear.

Cartilage grafting: Performed on rare occasions, usually at teaching facilities, when young, healthy cartilage with minor damage needs to be repaired.

Total or partial joint replacement: Replaces severely damaged joint surfaces with metal or plastic.

(Note: Arthroscopic surgery for the treatment of arthritis is not supported in the literature, according to AAOS guidelines.)