Knee and Hip Replacement More Than Just “Lifestyle” Surgeries
The question: My knee replacement surgery has been postponed due to the COVID-19 pandemic. I don’t know when it will be reprogrammed. The pain in my knee is excruciating. What should I do while I wait?
The answer: You are certainly not alone. Many elective – or elective – procedures were suspended when hospitals cleared bridges to make way for COVID-19 patients during the various waves of the pandemic.
And the waiting patients knee and hip surgeries were disproportionately affected by these delays, says Dr. Mohit Bhandari, president of the Canadian Orthopedic Association.
While hospitals struggled with limited operating room time, priority was usually given to patients requiring immediate and potentially life-saving surgical care.
Knee and hip replacements tended to be postponed because they were “seen as lifestyle surgeries, which is the furthest thing from the truth,” says Dr Bhandari. “These are restorative surgeries for debilitating conditions.”
“This unfortunate ‘lifestyle’ branding has deprioritized some of these patients who are truly in agony.”
Before the pandemic, the wait time for knee and hip operations ranged from six to 12 months. That wait will now be much longer until the backlog of cases is cleared, says Dr Bhandari.
Orthopedic surgeons are concerned that their patients will continue to deteriorate during the delay.
It is extremely important that patients who need knee or hip replacement surgery remain physically active, says Dr. Vickas Khanna, orthopedic surgeon and assistant professor at McMaster University in Hamilton.
A targeted exercise program strengthens the muscles that support the knee or hip and can actually reduce pain. Plus, exercise helps maintain a healthy weight, so there is less strain on problem joints.
Doctors generally recommend low-impact activities such as using elliptical machines, swimming, biking, walking, and Tai Chi.
However, Dr Khanna readily admits that “it is difficult to tell patients to exercise when they can barely move a knee or hip.”
In such cases, doctors may suggest various treatments to relieve the discomfort.
“Each option has advantages and disadvantages,” says Dr Khanna, adding that they may provide only “minimal benefit in people with severe degenerative changes in their joints.”
- An injection of cortisone into the joint can reduce inflammation and stiffness for four to eight weeks. But cortisone should be used judiciously. Research suggests that repeated injections can accelerate the deterioration of cartilage, the shock-absorbing material between bones.
- An injection of hyaluronic acid works for about six months. It is a synthetic material that mimics the natural lubricating fluid found inside healthy joints. Unlike cortisone, hyaluronic acid is not associated with the breakdown of cartilage. But the cost is not covered by most provincial health systems. Some private insurance plans will foot the bill. Patients without such coverage will pay around $ 500 out of pocket for the treatment.
- Platelet rich plasma, or PRP, is said to harness the body’s own healing powers and can relieve pain and inflammation for six to 12 months. Blood is taken from the patient and placed in a centrifuge. The machine spins the blood, separating it into different parts. Some of the components, such as platelets and growth factors, are used to produce PRP, which is then injected into the painful joint. Sometimes multiple injections are given over a period of several weeks. Each injection costs between $ 500 and $ 700.
Dr Moin Khan, orthopedic surgeon and assistant professor at McMaster University, says the effectiveness of injections, especially with PRP, can vary from patient to patient. “There are different commercial formulations of PRP on the market,” he says, adding that there is a lack of high-quality comparative studies showing which is the best.
In addition to injections, doctors may recommend a custom-made splint that redistributes weight on an unevenly worn joint. But, again, the price can be an issue for some patients. “A medical grade carbon fiber corset can cost $ 1,500,” says Dr. Khanna.
There is no doubt that the cost of some of these specialized therapies will put them out of the reach of many people.
Even so, “there is a lot that people can do on their own to maintain muscle strength,” says Dr. Jihad Abouali, orthopedic surgeon and assistant professor at the University of Toronto.
He notes that the Canadian Arthritis Society website provides information on home exercises for the knees and hips.
And, for pain control, doctors often suggest topical pain relievers, as prolonged use of nonsteroidal anti-inflammatory pills can cause stomach problems.
Despite their best efforts to stay in shape, some patients “will get worse when they are on the waiting list,” says Dr Bhandari. He believes that everything should be done to offer them a “corrective” surgery. “Patients who are in pain cannot wait.
Paul Taylor is a former patient referral counselor at Sunnybrook Health Sciences Center and former health editor of The Globe and Mail.