Why You Shouldn't Delay Joint Replacement

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here is your host, Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I’m Deborah Howell, and today we’ll be spending some time talking about joint replacement and why you shouldn’t delay. Our guest today is Dr. Sharoun Porat, an orthopedic surgeon at Saddleback Medical Center whose treatment philosophy is centered on holistic care for orthopedic injuries, including both surgical and non-surgical care. Welcome, Dr. Porat.

Sharoun Porat, MD: Thanks for having me.

Deborah Howell (Host): So, what are the very first signs of a joint problem?

Sharoun Porat, MD: You know, it’s pretty easy. Normally it’s pain. The trouble with that, of course, is that everyone experiences pain a little bit differently and most of us compensate with a little bit of pain. We all go through life with aches and pains that we can tend to ignore. But if you notice that your activities are being altered, if maybe you’re walking a little bit less, or if you’re having to park a little bit closer to the store when you do because it just hurts a little bit more to get there... those are signs that you realize that, oh, I’m actually compensating for pain and I’m just putting up with it. And those, if you’re aware of those things, that really becomes more of a signal that something should probably be done about it.

Deborah Howell (Host): Well, there’s a whole bunch of treatments. So what are some of the most common non-surgical treatments for joint pain?

Sharoun Porat, MD: Surgery is always the last thing that we talk about. So whenever we’re talking about arthritis or joint pain in general, we always start more conservatively and we start with the least conservative, least aggressive treatments - most conservative treatments - early on. So you talk about exercise programs, which could be included with physical therapy. You talk about weight loss, strength training programs. You can take over-the-counter anti-inflammatory medications, like Ibuprofen, things like that. And then you ramp it up as the needs arise, and that can progress to things like injections, whether it’s steroid injections or gel injections. And then if those aren’t working, then you start to get more significant and you start talking about surgery.

Deborah Howell (Host): And what are the early signs that someone needs to have a joint replacement surgery?

Sharoun Porat, MD: If those other treatments aren’t working for you anymore, then you start talking about surgery. And really, it’s you try everything else first, but if you realize, you know what, I’ve done these injections, I’ve tried therapy, and it still hurts... I still can’t walk at the mall, I can’t go to the store, I have trouble doing basic life activities, I can’t walk my dog, those kinds of things, and especially if it’s pain at night that affects sleep, we start talking about surgery.

Deborah Howell (Host): And can you tell me the difference between a partial and a total knee replacement?

Sharoun Porat, MD: It really is exactly how it sounds. So when we talk about the knee, there’s different parts of the knee. There’s the inside, the outside, what we call medial and lateral, and then there’s the front, which is the patellofemoral joint, the kneecap. And so those three parts can develop arthritis at different rates. So sometimes if people develop arthritis only in one part of the knee joint, then we could theoretically just replace part of the knee joint and do a partial joint replacement as opposed to doing the whole knee, the whole total knee replacement.

Deborah Howell (Host): And I’m sure that’s a much easier procedure and we’ll get into that. Does delaying a knee replacement lead to needing a total knee replacement versus a partial knee replacement?

Sharoun Porat, MD: You know, it really does not. People who are going to develop the kind of arthritis that responds to a partial joint replacement, those people tend to have that isolated disease long-term. And if you wait extended years, maybe 10, 20 years, you could possibly start talking about that, but that’s really uncommon. It’s really going to be partial or total depending on how the individual is developing arthritis. It really would take a long time for somebody who could potentially benefit from a partial to really need a total. I think that they wouldn’t tolerate it long enough to have to go through the transition.

Deborah Howell (Host): And for those who need both knees replaced, is it best to have them replaced at the same time or each replaced separately?

Sharoun Porat, MD: Now, this is not set in stone. This is one of those things that different people will give you different opinions on. There have been studies on people who’ve had joint replacements done both together versus separately. And if you look at those people a year later - those who’ve had both done at the same time versus ones who waited several months before the second - a year later they look about the same. So your outcomes are really about the same, except for one really critical factor: there is a slightly higher risk of catastrophic complications with people who have both joints done together. So if you’re older, if you have more health problems, it becomes really riskier to do both together. And for me, because I’m rather conservative, I tend to push people and recommend that they do one at a time. That’s not something that’s an official recommendation, but it’s generally what I tend to go with. Just I want to be as safe as possible for people. And if you have one good knee to stand on while you’re recovering, I think you do better. The studies say they do about the same.

Deborah Howell (Host): And how long after knee replacement surgery can a patient begin walking again?

Sharoun Porat, MD: Immediately. So the way we’re doing joint replacements now, people are getting blocks after, right before surgery. And you have the surgery, and you get up that same day and you start walking. And that is an immediate process. In fact, walking is part of the therapy, it’s part of the recovery. Now, you might not be able to go for long walks around the block immediately, that’s what you work towards, but you’re immediately up and on your feet, you’re immediately up and walking. And most patients now, we’re sending home either the same day or the next morning after surgery. We’re considering these essentially outpatient procedures now, whereas they used to be done where people stayed in the hospital for several days. But you really don’t find the need to do that anymore with modern anesthesia and pain control techniques. People can walk right away and get back to starting to make their recovery.

Deborah Howell (Host): Where were you 20 years ago when I needed you, Dr. Porat? I had the old-fashioned kind. (Laughs) So, do knee replacements last forever?

Sharoun Porat, MD: They don’t last forever. The official data - there isn’t a whole lot of new information yet - but the official data from a few years ago said that on average they last about 20 years. Now the plastics changed and a few things changed with the knee replacements about 15, 20 years ago. And now we’re doing things a little bit differently. In the laboratory, these new knee replacements should last longer. We don’t have in-person data to support that yet, but probably we’re looking at adding an extra five years or so. So let’s say 20 to 25 years is how long a joint replacement should last. And the good partial knee replacements, they also last about the same amount of time. They’re not forever, they last a long time. We’re having younger and younger patients wanting to have surgery now. We still recommend you wait for as long as possible before you do a knee replacement just because they don’t last forever and doing them again is much harder. But they do last quite a long time.

Deborah Howell (Host): What’s the record number of knee replacements on one patient you’ve ever done?

Sharoun Porat, MD: Me? I - I don’t do a whole lot of revisions myself. When it comes to knee replacements, we do - I do one and very rarely... I’ve been in practice for 12 years, so I haven’t had patients fail yet, I haven’t been in practice long enough yet for patients to have gone through knee replacements and need to have their revisions. So I do the one and honestly, I haven’t seen my patients come back yet. Orthopedics is nice, I get to make people better and I get to say hi to them on the street instead of back in the office again. So it’s - it’s a - it’s a nice field to be in for that.

Deborah Howell (Host): Do you have a particular patient that comes to mind, a real success story?

Sharoun Porat, MD: There’s so many, it’s hard to narrow it down. But I can think of people who really had a hard time just getting up and walking or were in a wheelchair for six months because the knee hurt too much, and I’ve done a knee replacement and they get back to life, get back to walking, get back to taking care of life activities instead of being bedbound or sitting in a chair. And that can make a dramatic improvement in a person’s life. And that’s happened more than once. I don’t think I could point out an individual because it - it does happen relatively commonly where people really are incapable of doing basic life activity. And with a joint replacement, because you no longer have pain and you can walk and you can get around, it’s a very rewarding result to get somebody back to things that make them happy.

Deborah Howell (Host): It’s almost as much mental benefit as it is physical.

Sharoun Porat, MD: Absolutely.

Deborah Howell (Host): We want to thank you so much, Dr. Porat, for being on our show today. It’s been great talking to you, as always.

Sharoun Porat, MD: Great. Thank you so much for having me. I appreciate it.

Deborah Howell (Host): For more info, please visit www.memorialcare.org/sbjointreplacement. To listen to the podcast, visit memorialcare.org/podcasts. I’m Deborah Howell. Thanks for listening, and have yourself a fantastic day.