6 signs that it may be time to have a joint replaced

An ailing knee or a hip can make life miserable. Even if your doctor recommends it be replaced, you need to carefully weigh the risks and benefits before agreeing to this major surgery and understand that it will require significant rehabilitation to get back on your feet.

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Do your knees or hips hurt? Most people will at some point have knee or hip pain because these large joints have a demanding task: they must bear the full weight of your body while at the same time allowing for a wide range of motion. Wear and tear, injury, and simple genetic predisposition can all contribute to knee or hip pain. This Special Health Report, Knees and Hips: A troubleshooting guide to knee and hip pain, covers a wide range of knee and hip conditions and describes in detail treatments, preventive strategies, and surgeries.

The most important factor in choosing to have a knee or hip replaced is how much it hurts and how much it is affecting your life. Here are six signals that it's time to have a knee or hip replaced:

You can no longer complete routine daily tasks without help.
You have significant pain, like pain that keeps you awake at night despite the use of medications, pain that keeps you from being able to walk or bend over, pain that isn't relieved by rest, or pain that isn't helped by non-surgical approaches.
Your doctor says that less-complicated surgical procedures are unlikely to help.
You have osteoarthritis and feel the disease is wearing you down physically, emotionally, and mentally.
You are suffering severe side effects from the medications for your painful knee or hip.
Tests show advanced arthritis or significant joint damage.

Finding the right surgeon and hospital can make a big difference to the success of your operation. In general, you're likely to have a better result and fewer complications if your surgeon performs the operation at least 100 times a year and operates in a hospital where replacements are routinely done.

If it's clear that joint replacement is a good choice, the questions below can help you decide whether a particular surgeon is right for you:

Are you board-certified in orthopedic surgery?
Are you fellowship trained?
How often do you perform this surgery?
What kind of results would you expect for someone in my condition?
May I speak with any of your patients who have had this surgery?
What complications occur most frequently, and how do you deal with them?
Do you usually work with a particular physical therapist or rehabilitation center?

For more on strategies for pain-free knees and hips and a special bonus section on knee and hip replacement, buy Knees and Hips: A Troubleshooting guide to knee and hip painby Harvard Medical School.

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Where to turn for pain relief - acetaminophen or NSAIDs?

The first line of treatment for many knee and hip problems includes taking over-the-counter pain relievers. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are the most common options. However, these medications have a variety of side effects, so it's important to discuss your personal health risks with your doctor when considering long-term use for chronic conditions such as osteoarthritis.

Acetaminophen (Tylenol and other brands) is usually effective for mild pain and is easy on the stomach. However, it is toxic to the liver at high doses. The recommended maximum per day is generally set at 4 grams (4,000 milligrams), which is the equivalent of eight extra-strength Tylenol tablets. But that dosage can still cause liver problems for some people. To be safe, aim for 3,000 milligrams or less, and be cautious of mixing multiple products containing acetaminophen, such as a pain reliever and a cold medication or a prescribed narcotic.

The FDA now recommends using products containing no more than 325 milligrams per pill or capsule (the equivalent of regular-strength Tylenol rather than extra-strength) in order to avoid excessive dosages. Don't take acetaminophen if you drink more than a moderate amount of alcohol on a regular basis or if you have liver disease.

NSAIDs such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Anaprox) may be more effective than acetaminophen for certain conditions because they reduce inflammation as well as relieve pain. But NSAID medications have side effects, the most common is stomach irritation. It can also cause stomach and intestinal ulcers, which can lead to internal bleeding. You can ask your doctor about taking a stomach acid inhibitor to reduce these risks. NSAIDs also carry an increased risk of heart attack, stroke, and kidney failure when taken at high doses or for long periods of time.

Taking acetaminophen along with an NSAID may provide equivalent pain relief with lower doses of both medications, thus minimizing side effects. You can also alternate between the two to reduce the risk from either type of medication.

For additional advice on reducing knee pain, buy Knees and Hips: A troubleshooting guide to knee and hip pain, a Special Health Report from Harvard Medical School.

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Featured in this issue

Knees and Hips

Featured content:

•	Knees in motion
•	Hips on the ball
•	Testing for knee and hip problems
•	Nonsurgical treatments for knees and hips
•	Special section: Knee and hip replacement
•	... and more!