….at a glance.
👉 getting frustrated that your GP is not referring you to the consultant for a joint replacement? Or at the consultant for holding off a joint replacement?
👉🏼 getting immense pain in the joint that is destroying your life? Surely this is arthritis and the joint is a mess and needs replaced? This is the only way of getting rid of the pain, right?
👉🏽 under 60 yrs old?
👉🏾 thinking about going private to get it done quicker. The quicker, the better.
👉🏿 thinking once I get my new replacement I am going to get the full range of movement back as well as no more pain.
Now have you considered the following responses:
👉 your GP or health professional has been to university for a number of years studying a profession which gives them a good knowledge base to make an informed decision.
👉 your GP, or health professional, will be listening as much as you don’t think they are. Listening and doing the best for our patients is our duty. It is what we have signed up for, well if it is not then they are in the wrong profession.
👉🏼 yes money is always going to be a bit of an issue (dare I say even more now…..) each primary care trust will be given quotas and a budget (less now). So, GPs have added stress to refer those who really need a replacement. Put yourself in their shoes.
👉🏽 all pain at a joint does not mean arthritis or that it is ‘destroyed’. Pain is NOT related to damage. We are aware from much high-quality evidence that conservative treatment has good success rates. There is no need for a replacement in all arthritic joints.
👉🏾 joint replacement inevitably needs revision (done again) after a period of approximately 15 years. It is a major operation although common. Each time the surgery is done the outcome quality is lower, as the surgeon must deal with a further deteriorated joint. The quality will only be as good as the materials that are available e.g. you only have mud to build a hut it must be made of mud!
Joint replacements are good quality, but they will never be as good as the natural knee joint. Substantial amounts of stress and forces go through the joint on a daily basis, the natural knee is equipped to withstand these to a certain point. However, a prosthesis (joint replacement) is not.
I attended a recent talk by a consultant at the nuffield whom specialises in knees. He described and showed images of one of his clients of approximately 80 years old. She had the worst gait/walk I have ever seen. The level of physical change gave rise to severe bowing which meant she needed a stick for walking to be safe. She already had a joint replacement and needed a revision. Although the consultant had done a fabulous revision job, just think how much her body had to endure in the process (I also appreciate we don’t have a comparison of how the joint may have been without an initial replacement).
Young people with juvenile arthritis will ultimately need replacements. However, these are the last possible route when other modalities have failed, or no longer help.
👉🏿 surgery has been documented as, and high quality evidence suggest it is, a very effective placebo. If you feel strong enough that the surgery will cure your pain….it has a high probability of doing so. If it is done in ‘private’ where there is on-suite, private rooms, brand new equipment, less patient to nurse ratios, then what is that going to do to the placebo response!!?
👉🏿 as we have said numerous times…..pain is not equal to damage. Fixing a physical problem does not mean fixing the pain.
Additionally, due to the physicality of the prosthesis and the change at the joint, range of movement equivalent to ‘what it used to be like’ before the onset of deterioration will not occur. A lot of patients think that the joint will be like having a ‘new knee’ equivalent of a young mobile joint. So, expectations are not met. Be prepared to be realistic with the outcome.
Take home message…..think seriously about having a joint replacement: is the right time.