If you are suffering from severe joint pain, it may be a sign that you need a joint replacement. You should consult with an orthopedic doctor that will recommend a treatment plan, possibly including surgery from a joint replacement specialist.
1. Your pain persists or recurs overtime
2. Your mobility has declined to a point you are no longer able to perform your daily activities comfortably
3. All conservative treatments are no longer giving you the relief you would like. For example, if taking ibuprofen, using a cane, or physical therapy has not improved your mobility or pain.
4. Your joint becomes stiff when you sit in a certain position for too long. Example, driving long distances or sitting down for an extended period causes stiffness or pain.
5. Your joint(s) ache during or after exercise.
Arthritis is the wearing away of the cartilage on the end of the bone.
“Be as active as you can be! The stronger you keep your muscles, the more mobile and healthier the joint will be. If you have arthritis, it will worsen no matter how you exercise. So, enjoy your life and once the quality severely worsens, that is when you should come see us!”
Sierra Denefe, PA-C to Dr. Raab
“Patients always ask, should I stop doing Zumba or walking since it hurts? Will it make my hip / knee worse? I think you can do all those things if you can tolerate the pain.”
Kirby Hamblen, PA-C to Dr. Raab
Joint replacement is a cure for arthritis. When you replace a joint, you have rid yourself of the arthritis.
We frequently receive questions about whether arthritis can come back. The answer is no. Joint replacement offers a new covering that was previously damaged or removed by arthritis.
Joint replacements may require additional surgery for a few reasons:
On average, joint replacements last 15-20 years. Some factors such as weight or lifestyle can affect the length of time joint replacements last.
Osteoarthritis is the most common type of arthritis, usually affecting the hands, knees, hip and spine. This chronic condition causes the cartilage between bones that cushions the joints wears down and the bones rub against each other causing pain, stiffness, swelling, and reduced range of motion.
What causes osteoarthritis?
Our surgeons will try all conservative measures before jumping to surgery. A few examples of treatments for knee pain include:
Rheumatoid Arthritis is an autoimmune disease where your body attacks cells in your body, causing painful swelling in affected areas. This painful disease mainly affects the joints, usually many at a time.
While there's no cure for rheumatoid arthritis, physical therapy and medication can help slow the disease's progression. Most cases can be managed with a class of medications called anti-rheumatic drugs.
Bone tissue may deteriorate from a condition called avascular necrosis. In avascular necrosis, the blood supply for the bone depletes resulting in bone damage and severe pain.
Avascular necrosis can occur in any joint, but it is most often found in the hip, shoulder, or knee. A joint replacement is the only cure for avascular necrosis.
Stage 1: X-rays and MRIs show a dead bone
Stage 2: cystic or density changes in the bone are detected
Stage 3: subchondral lucency or crescent sign
Stage 4: flattening of the femoral head
Stage 5: joint space narrowing begins
Stage 6: advanced degenerative changes
The only cure is a joint replacement. In the beginning stages of the condition, conservative treatments for pain management are administered. Once the patient is no longer able to have a good quality of life, surgery will be discussed between the patient and surgeon.
Surgery can be performed at any stage of Avascular Necrosis. This depends on the individual patient and their pain during each stage. Similar to a joint replacement for arthritis, joint replacement for avascular necrosis cures the condition and rids the joint of avascular necrosis.
One of the biggest risk factors is heavy alcohol use, steroid use, and chemotherapy/radiation treatment. It is also commonly found in younger males or those who have had blunt force trauma (fractures) in the bone. However, according to Kirby Hamblen, PA-C, 70% of patients have no underlying cause of the condition.
A patient cannot receive steroid injections to treat AVN. A steroid injection will speed up the avascular necrosis and cause the condition to worsen. Therefore, a joint replacement is ultimately the only cure.
Commonly the knee, hip and shoulder can be replaced. Other uncommon joint replacements include the fingers and ankle. At Elite Sports Medicine + Orthopedics, the following physicians perform these specific replacements:
Dr. Raab: Hip and Knee Replacement
Dr. Price: Shoulder Replacement
Dr. Sam Crosby: Finger Replacement
Dr. Thomson: Ankle Replacement
Dr. Dierckman: Knee and Hip Replacement
When the joint is bone on bone. In other words, when there is little to no cartilage left in the joint, and the patient has gone through all other conservative treatments, it may be time for a knee replacement.
“If the patient’s x-ray and MRI show enough damage, and the patient’s quality of life is being seriously affected, that is when it’s time to start thinking about a knee replacement.” Kirby Hamblen, PA-C to Dr. Gregory Raab.
Many patients ask if it is too late to have a knee replacement. Unless the patient has serious health complications, it is never too late. Arthritis will not reach a point where knee replacement is unable to be performed.
Once the cartilage has deteriorated, joint replacement may be necessary. Speak with a knee replacement specialist about treatment options.
It is common for highly active people and professional athletes to start considering a knee replacement early on in life. These types of patients may have significant damage visible on an X-ray or MRI, which might be negatively affecting their quality of life. However, it is advisable to try all conservative measures before jumping into major surgery. The younger the patient is, the more risk there is of wearing through the new cartilage, which will lead to a revision surgery.
The main takeaway for younger patients should be to look at your current quality of life. If you are unable to do things such as play with your kids, perform your daily activities, and you have tried all other conservative options, it is important to talk with a specialist to see if knee replacement may be right for you.
After your initial post-op appointments, our surgeons have follow-ups every two years to check X-rays. This helps maintain the joint and spot issues before they may rise or cause pain.
It takes a full year to recover from a joint replacement and not “feel” like you have a new joint. It takes this amount of time to build back your stamina and muscle around the joint. Though you are recovering for a year, that does not mean you will be in pain for a full year.
Most patients struggle the most in the first two weeks. This is when your pain is at the highest and you are the least mobile. After week two your outer incision is healed, but the deeper layers still take more time to heal. During week 2-6 you are in physical therapy, pain medication dosage decreases, and patients become less dependent on canes and walkers to get back to a normal life.
Around week 5 patients can drive and start resuming more normal activities. From week 6-12 patients will start noticing more weekly accomplishments opposed to daily.
Yes, a joint replacement completely cures arthritis in the joint being replaced. Additionally, the arthritis will not come back after joint replacement surgery.
Typically, patients can return to work in 3-4 weeks. Depending on the physical labor of your occupation, it may require additional recovery time. Full recovery from a knee replacement, meaning your new joint does not feel “new” anymore, takes about one year.
Since joint replacement surgery is an invasive procedure, it is important to see someone who specializes in joint replacement and has extra training in the field. Our joint replacement doctors are fellowship trained, meaning they have extra training specifically for joint replacement surgery.
Dr. Gregory Raab
Gregory Raab, MD, specializes in total joint replacement and revisions of the knee and hip. Dr. Raab has been named one of Castle Connolly’s Top Doctors from 2016-2021, making him one of the best joint replacement specialists in Nashville, TN.
Thomas Dovan, MD, specializes in orthopedic surgery of the hand and upper extremity. Dr. Dovan has been named one of Castle Connolly’s Top Doctors from 2014-2021
Chad Price, MD, specializes in sports medicine and arthroscopic surgery of the hip, knee, and shoulder.
Samuel Crosby, MD, specializes in orthopedic surgery of the hand and upper extremity for adult and pediatric patients. Dr. Crosby finished as a runner-up in Nashville Fit Magazine’s 2020 “Best Orthopedic Physician” poll.
Brian Thomson, MD, specializes in orthopedic surgery of the foot and ankle. Dr. Thomson was recently named a Castle Connolly Top Doctor for 2021, placing him among the best foot doctors in Nashville, TN.
Brian Dierckman, MD, specializes in sports medicine and arthroscopic surgery of the knee, hip, and shoulder for both adults and children. Newer to Nashville, Dr. Dierckman is known for his tremendous bedside manner, surgical skills, and passion for orthopedic care.
If you are suffering from joint pain, you may need to request an appointment with a joint specialist near you.