How to decide if joint replacement is right for you

Robotics, advanced materials and new anesthetic techniques are helping to make joint replacement surgery a much simpler and less invasive procedure for patients.

“Ten years ago it was common for patients to have a three-day stay,” said Dr. Brent Whited, an orthopedic surgeon at Steindler Orthopedic Clinic in Iowa City. Today, Whited said, many patients can go home the same day of their surgery.

Dr. Sandeep Munjal, an orthopedic surgeon at Physicians’ Clinic of Iowa in Cedar Rapids, said robotic-assisted surgery offers many benefits.

“Robotics in joint replacement allows for greater precision in bone preparation, implant sizing and positioning,” he said.

“The robotic arm or navigation system can guide the surgeon’s instruments within predefined boundaries, minimizing errors and ensuring more accurate execution of the surgical plan.”

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Munjal has been doing knee and hip replacements with PCI since 2015. He performs the surgical procedures at Mercy Medical Center, St. Luke’s Hospital, Surgery Center Cedar Rapids and Mercy Surgery Center in Hiawatha.

But robots cannot take the place of humans. “It’s important to note that while robotics in joint replacement surgery offers several potential benefits, it does not replace the skill and expertise of the surgeon,” Munjal said.

Whited said that spinal anesthetics have improved joint replacements by reducing pain, while anti-inflammatory treatments allow the patient to recover more quickly.

“By around six weeks, most people are doing most of the things they used to do,” Whited said. “Nothing makes me happier than getting a patient back on their feet, so a grandparent can go to their grandkid’s baseball game.”

Along with those improvements, interest in joint replacement is growing, and health care providers are looking for ways to meet that need.

Steindler recently broke ground on a six-bed ambulatory surgery center and orthopedic clinic in North Liberty, which is expected to open in early 2025. Steindler CEO Patrick Magallanes said the new, larger location, with its proximity to the Eastern Iowa Airport, will allow Steindler to treat more patients and make it a regional destination for orthopedic care.

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The University of Iowa Hospitals and Clinics is also building a hospital in North Liberty that will offer orthopedic services. That facility is scheduled to be complete in December 2024.

The knee, hip and shoulder are the most common joint replacements

To decide whether the surgery is right for you, Munjal and Whited said patients should consult a medical professional like an orthopedic surgeon. Based on a comprehensive evaluation of your medical history, symptoms and diagnostic tests, an informed decision can be made.

Here are some questions to consider:

How severe is your pain?

“Joint replacement surgery is usually recommended for individuals who experience persistent and severe joint pain that significantly affects their daily activities and quality of life,” said Munjal. “If pain medications, physical therapy and other non-surgical treatments have been ineffective, surgery might be considered.”

Whited agreed. “Does the pain wake you up at night? Does it impact what you want to do? Those are some things to consider”

How much joint damage is there?

X-rays, MRIs or other imaging tests are used to assess the extent of joint damage.

“Joint replacement surgery is typically performed when there is substantial joint deterioration, such as advanced osteoarthritis or rheumatoid arthritis, where the joint cartilage is worn down, resulting in bone-on-bone contact,” Munjal said.

Have more conservative treatments failed?

Before surgery is considered, a series of more conservative treatments need to happen if you are a candidate for joint replacement surgery. These treatments may include pain medications, physical therapy, assistive devices, joint injections or weight loss programs. Surgery may be recommended if these options do not provide adequate relief.

What is your overall health and medical history?

Both play a crucial role in determining candidacy for surgery. Factors like age, presence of chronic diseases (diabetes, heart disease), obesity and previous surgeries will be considered. Your doctor will evaluate whether you can tolerate surgery and the subsequent rehabilitation process.

Are your expectations realistic?

“You’ll never have the same knee you had in your twenties,” said Whited. “But it will be far better than an arthritic knee.”

Patients should talk with their doctor about managing their expectations, Munjal said.

“Joint replacement surgery can improve quality of life and reduce pain, but it is essential for candidates to have realistic expectations about the outcomes,” said Munjal.

Modern joint replacements can last between 15 and 25 years, depending on certain factors. Patients can also undergo joint replacement regardless of their age.

“Both younger and older adults can benefit from joint replacement surgery if they meet the necessary criteria,” Munjal said.

Risks of the surgery are relatively low, but there are things to watch for, Whited said. Patients who have certain cardiac conditions may be at a higher risk, “but usually these things are manageable,” he said.

“As with any surgical procedure, joint replacement surgery carries risks such as infection, blood clots, adverse reactions to anesthesia and complications related to wound healing,” Munjal said.

Patients who choose joint replacement can look forward to long-term pain relief and an improved quality of life, Whited said.

The length of time from the initial consultation to recovery can take several weeks to months, depending on individual factors and the complexity of the surgery.

“Remember, the decision to undergo joint replacement surgery is highly individual, and it’s important to take your time, gather information and consult with health care professionals,” Munjal said.