Health Features

Joint Replacement

An estimated 27 million Americans suffer from osteoarthritis or degenerative arthritis—an astounding figure. There are things you can do to protect your joints, including maintaining a healthy weight, exercising and avoiding inflammation-causing foods. If you already have joint pain, the good news is many noninvasive therapies might help, such as acupuncture and chiropractic. And if all else fails, there’s a good chance that joint replacement surgery can restore your quality of life.

Just like you can’t un-boil an egg, you can’t reverse osteoarthritis. That’s why it’s so important to protect your joints. Osteoarthritis is a disease that primarily affects cartilage, the tissue that covers the ends of bones and allows bones to glide over each other. When the top layer breaks down, the bones begin to rub together, resulting in pain, swelling and loss of motion.

a weighty issue
Maintaining a healthy weight is always important, but it’s especially crucial for joints. “Excess weight puts a lot of pressure on your joints, particularly the knees and hips,” says Iris Salsman, a weight management coach and owner of Been There Done That. “According to an article published by Harvard Medical School, when you walk across level ground, the force on your knees is the equivalent of 1.5 times your body weight. That means a 200-pound man will put 300 pounds of pressure on his knees with each step. Add an incline, and it’s greater. Losing a few pounds can go a long way toward reducing the pressure on your knees.”

Salsman knows this firsthand. After a hip and knee replacement, she lost 135 pounds and has kept it off. She says she has much more strength, stamina and flexibility now.

Dr. Varsha Rathod, an internist and rheumatologist who focuses on holistic healing at her practice, Preventive Medicine, says excess fat also can cause inflammation, which leads to joint destruction. “There are two ways to put on fat. The first is around the middle, called visceral fat. This is associated with inflammation that we don’t even realize is due to fat and resistance to insulin,” she says. “The second kind is called superficial fat and leads to the pear-shaped body. It’s associated with a tendency to experience gut dysfunction and food sensitivities that cause joint pain, hormonal dysregulation and the inability to detox efficiently. It also results in inflammation.”

food for feeling better
Rathod recommends eating a diet high in anti-inflammatory foods, like vegetables, fruits, nuts and seeds, lean meats, fish, eggs and herbs. Avoid foods that are high in sugars, refined carbohydrates, salt, and unhealthy fats and oils. She also recommends several supplements and vitamins, including glucosamine, chondroitin, MSM and collagen peptides for protecting cartilage. For inflammation, she recommends several natural anti-inflammatories such as turmeric, boswellia, ginger, tart cherry and fish oil. Finally, vitamin D is good for helping the early pain of osteoarthritis and keeping your bones healthy.

Drinking plenty of water also can help. “Cartilage is made up of sponge molecules called proteoglycans and glycoaminoglycans, whose main job is to absorb water and swell up, allowing our cartilage to act as a better shock absorber. It can protect us better against injury than thirsty, dehydrated and nearly cracked cartilage,” Rathod says.

a cautionary tale
Rathod warns that physicians may write prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDS) to allay pain at the cost of increased joint destruction. “Long term, these NSAIDS actually accelerate joint destruction by preventing the synthesis of collagen, bone remodeling and more,” she says. Additionally, if you are overweight and have any arthritis pain, high-impact exercises that involve jumping or running are not for you, Salsman adds. Contact sports also can lead to further joint destruction. Low-impact exercises like swimming or an elliptical are much easier on the joints.

“We cannot prevent arthritis with the standard American diet of animal protein and refined foods, with few vegetables and fruits,” says Rathod. “We can prevent it with a lifestyle shift, by making most of our diet anti-inflammatory, with an emphasis on plantbased and minimally refinined eating.”

[what are the options?]
The idea of getting a brand-new knee or hip is appealing; what 65-year-old wouldn’t be tempted to regain a full range of motion after years of a bum knee or hip? But doctors warn to ‘look before you leap’ when it comes to surgical options. They recommend trying conservative, non-invasive therapies first. These won’t cure osteoarthritis, but they may provide pain relief and delay the need for a joint replacement.

love the hip you’re with
“Even routine surgeries are a big deal and can have side effects and a long healing time,” says Rachel Loeb, D.C., of Clayton Chiropractic Center. “Also, if the cause of the degeneration is improper use, correcting the problem will reduce the likelihood of needing to repeat the replacement surgery or delay it. Trying at least one alternative is recommended before surgery.”

Althea Eller, D.C., who specializes in Chinese medicine nutrition and chiropractic care at Innovative Health Partners, says fake joints are limited in terms of movement capabilities. While the majority of people are happy with their joint replacements, don’t expect to have the knees of a 20-year-old post- surgery. “You’re always better off getting the most out of your real joints,” Eller says.

what are the alternatives?
First and foremost, try eliminating white sugar, white flour and fried foods from your diet for two weeks and see how you feel, advises Eller, because these are known sources of inflammation and the bane of arthritis. “Osteoarthritis is an inflammatory disease, and 90 to 95 percent of inflammation is caused by diet,” she says. Try to reverse inflammation, Eller says, adding that you might also lose a few pounds, which can only help your joints.

Acupuncture, a form of traditional Chinese medicine that aims to correct energy imbalances, is another way to try to mitigate the pain of osteoarthritis. “Researchers have done brain scans of people with arthritis, and when patients do acupuncture on a site with joint pain, it causes the brain to release endorphins and enkephalins, our body’s natural pain relievers and anti-inflammatories,” says Eller. “What’s incredible is that acupuncture appears to signal to the brain the exact location of the inflammation. And it can work for all joints, although some have more complicating factors.”

Then there is movement and manipulation, which flush out inflammation in the joints and bring in nutrients, Eller explains. Chiropractic care, for example, can help restore normal movement by adjusting “any kind of weakness or tightness that pulls the joint out of place and adds to wear and tear,” she says. Its effectiveness, though, will be limited by the extent of damage to the joint and other contributing factors. Another movement-based approach is physical therapy, which, if followed up with regular home exercises, can provide lasting relief, Eller adds.

If after trying alternative therapies, osteoarthritis is still limiting your lifestyle, it may be time to consider joint replacement surgery. “Sometimes the joint is too worn, and replacement surgery is the best option for long-term pain relief,” Loeb says. The good news is that experts say most people are happy with their joint replacements and are able to live a normal, active life.

[unexpected results]
Hip and knee replacement surgery are among the top three most successful surgeries in restoring quality of life; just ask most people who have done it. Approximately 85 percent of these patients are extremely pleased with their result. But what about the other 10-15 percent? For most of them, the results just didn’t live up to their expectations, and for about 5 percent, something went wrong.

failure is an option
There are a number of reasons why a joint replacement may fail, according to Dr. Denis Nam, a Washington University orthopedic surgeon who specializes in joint preservation, resurfacing and replacement. Infection, which occurs in 1 percent of patients, is always the biggest concern because it is difficult to treat and very disruptive to the patient’s life. The replacement joint must be taken out and replaced with a spacer. The patient is treated with an intravenous antibiotic for at least six weeks before another joint replacement can be put in. Fortunately, this is relatively uncommon.

Failures may also occur because the liner wears out. “Just like the tires on a car, the highly formed plastic liners used in joint replacements can wear down over time,” Nam says. “The plastics used now are much better and this is less common, but it’s still a potential problem, especially if the patient puts a lot of demands on the joints, like running or jogging.”

“Some patients experience pain when the liner wears out because it decreases the space between the metal pieces, forcing the muscles to provide stability,” explains Dr. Robert Otto, a surgeon with Premier Care Orthopedics and Sports Medicine. It’s important to get regular X-rays to ensure the joint and liner are in good condition and to catch any problems early on, he says.

If the joint becomes dislocated or loosened from the stem and cup, or if the stem fails altogether, it will most likely need to be replaced, Otto says. This is most common around 10 to 15 years post-surgery. Longer stems may be needed to provide extra stability, too. The downside to this is the patient loses more bone with each procedure, and longer stems can limit movement.

demand & re-supply
Joint replacement failures are likely to become even more common as people are living longer with their artificial joints. Years ago, this kind of surgery was done almost exclusively on patients 65 years and older. Today, 50 percent of patients are younger than 65, many in their 40s and 50s, Nam says. There are a number of reasons for this trend, including a rise in obesity and in adult participation in contact sports.

Younger patients not only expect more out of an artificial joint, but they also put more demands on it. “A joint replacement will vastly improve your quality of life, but it’s still an artificial joint,” reminds Nam. “It will not feel like your 20-year-old knee in your prime. You may have occasional aching and swelling, especially with a knee replacement.”

protect your new joint
The best thing you can do to protect your joint replacement from prematurely wearing out is to avoid high-impact activities like repetitive running, Otto says. “They’re made to be used, but it’s best to limit yourself to low-impact activities like walking, biking, swimming and hiking,” he advises. And if you’re significantly overweight, losing weight can also improve your outcome.

Building up the supporting muscles is also a good idea. “Muscle strength around the joint is intuitively helpful. It’s hard to say for sure if it will increase the wear, but it will improve patients’ function and make them feel much happier to have a strong core muscle around the joint,” Nam adds.