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Most patients who come to my office for arthritis have what is known as osteoarthritis. This is the wear-and-tear type of arthritis thought to be the result of years of impact on your hip or knee joints. This causes the cartilage, the smooth gliding cushion on the joint surface, to wear out. You can think of it like years of driving your car. If you wear through your rubber tires and are driving on the metal rims of your wheels, you are in for a bumpy ride.
When it comes to arthritis, I believe weight is an issue. Having a background in engineering before medical school, I like to think about hip and knee joints as mechanical devices. These devices can only withstand a certain amount of pressure through a number of cycles over a period of time. In other words, if a patient is heavier, or does a lot of heavy labor involving those joints, those individuals may be more at risk of wearing that joint out over the course of a lifetime. Likewise, with joint replacements, those devices would wear out faster in heavier patients.
It is very likely that losing weight will help people who have arthritis. Less weight means less pressure on the joint. For an arthritic joint that already has a damaged surface, losing weight can significantly relieve pain.
When I meet a new patient, I recommend nonoperative treatments before surgery and that includes weight loss. We have some great resources here at The Miriam Hospital. I have had overweight patients with severe arthritis who were specifically referred to me by their primary care provider for a joint replacement. After losing a significant amount of weight from The Miriam program, they felt their pain that brought them into my office was no longer severe enough for them to want the surgery. That’s a big win for the patient: their pain improves without ever having surgery.
The benefit of weight loss is not just limited to their joint. People usually experience an amazing transformation after weight loss. Other medical conditions such as diabetes improve or are cured, their mood improves, and overall, they just feel better.
While we do not want to keep anyone from a surgery that could help them, some patients are at a much higher risk for complications than others. I believe we as conscientious physicians should work as partners with patients and their other doctors to decrease as much risk as possible before joint replacement surgery. This is an area of active study for us here and we have already published on our experience in the Rhode Island Medical Journal.
There is a lot that we can do together. We can help heavier patients lose weight, nicotine users quit their habits, patients with many cavities or dental infections see dentists before surgery, and diabetic patients better control their blood sugar. Many studies have shown that heavier patients, nicotine users, patients with dental infections, and diabetic patients with high blood sugar are at higher risk for infection and don’t heal as well after joint replacement surgery.
This conversation is difficult to have with patients in the office, but I believe it is an important one. It can take some time and a real team effort to meet these goals, but I believe it can improve surgical outcomes and help patients heal better.
Osteoarthritis is a progressive disease. Unfortunately, there is not a magic pill or cure yet, although we are excited for promising studies of new, less invasive therapies that are currently being researched in our lab.
We do have many effective, nonoperative treatments that are already available to our patients in the office that can provide years of arthritis pain relief. They include:
When nonoperative treatments have failed, joint replacement surgery, performed by an expert surgeon, is a very effective and safe surgical treatment. It also has some of the best long-term results of any surgical procedure.
In our practice, we are proud that our results and expertise in joint replacement surgery rival those of any hospital or surgery center anywhere in the world.
Everyone is unique, and we treat each patient as such in our practice. If you are suffering from hip or knee pain, it is always best to talk with an orthopedic surgeon. There are lots of treatments we can offer to help you feel better.
That said, there are some rules of thumb that will likely help a patient see more success in hip or knee surgery. Some general goals for a patient seeking joint replacement surgery would be to:
The most important advice I can give arthritis patients is to live an active, healthy lifestyle. By this, I mean follow a healthy diet, exercise, and seek routine medical checkups. This will not only help prevent health and arthritis problems, but more importantly, it will also help make you feel better and live longer.
Health maintenance is key. Often in our society, we look for the quick and easy fix and that is not always best. The reality is a little bit of prevention each day, with physical hygiene and watching what we eat, is best for our long-term health. Living an active healthy lifestyle will likely take you the farthest in the long run.
Dr. Derek R. Jenkins is a board-certified and fellowship-trained orthopaedic surgeon specialist in hip and knee replacement surgeries. He is an Assistant Professor of Orthopaedic Surgery at The Warren Alpert Medical School of Brown University and operates at The Miriam Hospital and Rhode Island Hospital as part of the Lifespan Orthopedics Institute. He is a member of the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons. Dr. Jenkins reviews research articles for scholarly publications, has been published in the prestigious Journal of Bone and Joint Surgery and has presented research at national and international orthopaedic society meetings.