By R. Scott Oliver, M.D.
Regular exercise, a good diet, and maintaining a proper weight are key steps medical experts consistently recommend for good health and healthy aging. They also make good prescription for healthy joints. But it seems not enough people are heeding the advice.
Joint replacement is booming in health care, as more than a million people every year are getting new joints, usually hips or knees, full or partial, and the number is expected to increase as baby boomers approach their mid-sixties and wish to continue active lifestyles.
Among the causes of joint replacements, a few are more prevalent than others. Osteoarthritis, or degenerative arthritis, occurs as a result of the normal wear and tear of the joints over years of use. The cushioning between the bones – the cartilage or meniscus – simply wears out, as the tread of a tire wears from constant use. As a result, bone begins rubbing against bone, and that brings pain. Strenuous overuse can contribute to premature wear and tear; this is what often happens to professional athletes from years of stress on the joints.
Arthritis can encompass more than 100 different conditions affecting the muscular and skeletal systems and includes rheumatoid arthritis, psoriatic arthritis, and gouty arthritis. According to the Arthritis Foundation, some 50 million adults have doctor-diagnosed arthritis, with the most common form being osteoarthritis.
Another major cause also happens to be one of the nation's biggest health concerns: obesity. The U.S. Centers for Disease Control and Prevention (CDC) estimates that more than one-third of adults are obese, with adults over 60 years old more likely to be obese than young adults. Carrying too much weight wears down the joints faster because the body has to accommodate the extra pounds.
Patients should note that these factors, as well as injury and genetics, are related to some degree and can all play a role, individually or in combination, in deteriorating joint health.
Excess weight presents another problem. If a new joint is placed in a patient who is too heavy, the joint will only last a few years, and that's not helping the patient. In some cases, patients will be advised to undergo weight-loss surgery before joint replacement surgery.
While joint replacement is becoming more popular, patients must recognize that the surgery is more complicated than simply swapping an old joint for a new one. To achieve the best outcomes, surgeons will often recommend that patients undergo "prehabilitation" – to ensure that the patient's muscles are as strong as possible and that the body is ready for surgery. In preparing for surgery, it's best for the patient to be in good physical shape, to be at a proper weight, and, if heart disease is present, to check with a cardiologist to make sure the heart is strong enough for surgery because the biggest stress of surgery is on the heart.
Replacing joints can relieve pain and make people active once again, but patients must also realize that a new artificial hip or knee isn't the same as the original. A period of recovery and rehabilitation after surgery will be needed, and it will be necessary to modify activity. High-intensity activities, for example, like jogging, are inadvisable. But with proper care and modification of activities, hip and knee replacements should last 20 years or more.
The connection between joint health and overall health is critically important. Unless a person has good hips and knees, exercise is difficult if not impossible, and exercise is great medicine for a strong heart and overall good health. So it's important to keep the skeleton going to keep the heart going.
I urge patients to do what they can to keep the body's original parts, and the best way to do that is to remember this: you have to get into good shape to get old.
For more information on joint health and joint replacements, visit the American Academy of Orthopedic Surgeons at www.orthoinfo.org
For a video discussion and additional websites, visit www.physicianfocus.org/newjoints
R. Scott Oliver, M.D., is a board-certified orthopedic surgeon at Plymouth Bay Orthopedic Associates in Duxbury, Mass. and Chief of Orthopedic Surgery at Jordan Hospital in Plymouth. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.