Considering Joint Replacement? Why Older Adults Should Think Twice

Stiff, achy joints are no fun. But before you consider surgery, take these steps to find relief.

Debating getting a new hip, knee, or shoulder? Join the club. You likely need both hands to count the number of friends who’ve already had joint replacement surgery.

In 2018, over 1.2 million primary shoulder, hip, and knee joint replacements were performed in the United States, says Neil P. Sheth, M.D., chief of orthopedic surgery at Pennsylvania Hospital in Philadelphia.

The fact that “total joint replacements have demonstrated excellent long-term clinical results” is one reason for the procedure’s popularity, says Dr. Sheth. The aging baby boomer population is another: The older you get, the more your joints may deteriorate, or the more likely a past joint injury begins to limit your mobility.

“As people over 65 become more active and want a better quality of life, more are seeking total joint replacements,” says Stuart J. Fischer, M.D., an orthopaedic surgeon in Summit, New Jersey. “Newer techniques and longer-lasting components have made surgery a good option for active patients.”

The Downsides of Joint Replacement Surgery

As exciting as the prospect of a brand-new joint can be, replacement surgery doesn’t come without side effects. Although rare, complications can include infections, blood clots, heart attacks, damage to blood vessels or nerves, and instability or fracture around the implant, Dr. Sheth says.

Most concerning, the risk for post-op complications goes up with age, according to a study in the Journal of the American Geriatrics Society. It’s not necessarily your age that’s the problem, but the host of chronic conditions that all too often go along with getting older, say experts.

Factors like frailty, smoking, mental impairment, and depression can also increase your risk of adverse outcomes after elective surgery, according to a 2018 report in BMC Medicine.

Other evidence shows that shiny new joints don’t always deliver on their promise. Looking at knee replacements, for example, one study found that up to one-third of those who get a new knee continue to experience chronic pain. While another report found that the common knee surgery had “minimal effects” on quality of life.

And one in 37 women over the age of 85 who opt for a shoulder replacement will need a re-do within five years.

The good news? There are a number of proactive things you can do to stave off getting a joint replacement.

Delay Tactic #1: Go for a Walk

This might sound counterintuitive if you have painful joints, but staying active is important. “Exercise will strengthen the muscles around the joints and take some of the pressure off them,” explains Dr. Fischer. “It will also help preserve motion in the joint if arthritis is beginning to cause stiffness.”

Along with upping your outings, consider booking a series of sessions with a physical therapist. PTs can show you how to exercise safely by modifying moves to work within your range of motion and prevent further joint damage.

Dr. Sheth encourages patients to try joint-friendly exercises, like swimming or riding a stationary bike, or using a stair stepper or elliptical machine at the gym. “These gliding type activities may cause less discomfort,” he says.

Practice patience. Studies looking at the benefits of exercise programs for individuals with hip osteoarthritis, for example, found that it takes about 12 weeks for pain levels to diminish and strength and mobility to improve, according to the Arthritis Foundation.

A good beginning goal, says Dr. Fisher, is aiming for 20 to 30 minutes of exercise three to four times each week. Discover some of the best physical therapist-approved exercises for your knees here, hips here, and shoulders here.

Delay Tactic #2: Step on the Scale

You can be thin and suffer from stiff, achy joints. But if you’re carrying any excess weight, your joints definitely aren’t going to be happy. That’s because being overweight or obese does more than damage your heart, lungs, and liver, Dr. Sheth says. It also harms your joints.

It’s a matter of physics. Every time you take a step, your hips and knees experience additional force across those joints.

“If your joint is already arthritic, this will result in more pain and potentially decrease the time over which your remaining cartilage will wear out,” says Dr. Sheth.

For every pound you lose, you’ll take four pounds of pressure off your bad joints, according to a study in Arthritis and Rheumatology. If you’re about 10 pounds overweight, that could add up to 40 pounds of pressure taken off!

Of course, losing weight after the age of 60 isn’t as simple as cutting calories. Your body has specific nutritional targets that you’ll need to hit in order to stay healthy.

Protein is especially important, since it helps preserve your muscle mass. You’ll also want to make sure you continue to get enough fiber—preferably in the form of vegetables, legumes, and whole grains—for proper immune function and digestive health.

Check out these seven protein-packed vegetables that can help you hit both targets. If you need more help, a registered dietitian can set you up with a personalized meal plan that fits your health needs and your individual tastes.

Delay Tactic #3: Take a Shot

Exercise and weight loss are the first steps to take if you want to avoid surgery, but doctors also recommend taking over-the-counter anti-inflammatory medication and applying ice or heat to help alleviate acute pain.

If those remedies aren’t enough or aren’t safe for you to try, your doctor may suggest a series of injections, spaced a few months apart, for a limited time. There are two main types:

• Corticosteroid (steroid) injections are used to calm inflammation and minimize pain and swelling in the affected area.
• Hyaluronic (HA) injections are approved by the Food and Drug Administration (FDA) to treat the knee. The gel-like substance lubricates the cartilage to help improve shock absorption, so the joint can move more freely.

These methods don’t work for everyone—and sometimes patients report relief after early injections, but no noticeable relief after follow-up injections. There’s even evidence that people who take the shots may benefit from the placebo effect.

A 2017 study found that people with knee arthritis reported the same pain relief whether they received a steroid or saline shot. Plus, the steroid group experienced additional cartilage damage from the shot itself.

The American Academy of Orthopaedic Surgeons remains neutral on the idea of injections. The bottom line, experts say, is that injections have a place in the tool kit, but should not be considered a long-term treatment option.

When Should You Consider Joint Replacement?

In many cases, nonsurgical treatment may bring the relief you need. But in others, it may not. Even if you’re following all of these strategies, joint replacement ultimately may be necessary, says Dr. Sheth.

“When you start to limit your life for your joint, which means you’re not doing specific activities of daily living because you’ll end up with pain for the next several days, then it’s time to consider an evaluation by a specialist and discuss the possibility of joint replacement surgery,” he says.

Fortunately, if you’re healthy enough to undergo total joint replacement, the current protocols for surgical technique, post-operative rehabilitation, and pain control are so advanced that most older adults return to a high level of functioning. Check out our guide to recovery after knee replacement surgery.

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