Knees and hips take a lot of abuse, especially if someone is overweight or overactive. The time may come when aspirin and some downtime aren't enough to keep you going.
That's where hip and knee replacements come in. Damaged parts of the joint are replaced with plastic or metal substitutes. According to the American Academy of Orthopaedic Surgeons, about 581,000 knee replacements and 193,000 hip replacements are performed each year in the United States. Ankle, shoulder, elbow and finger joints can be replaced, too, but hips and knees are the most common.
Here's what you should know if you're thinking about a joint replacement -- or already have one:
1. THE BENEFITS CAN BE MAJOR
"People worry about how painful it will be afterward," said Dr. Richard J. D'Agostino, chief of orthopedic surgery at St. Francis Hospital in Roslyn. "But 90 percent of people who have a joint replacement say, 'This feels so great, I don't know why I waited so long to get this done.' "
The biggest benefit is pain relief, allowing people to return to an active lifestyle, said Dr. James Capozzi, chairman of orthopedics at Winthrop-University Hospital in Mineola. But side effects such as infections and joint dislocations can occur, and people are urged not to overextend themselves physically with high-impact sports. "Patients have to respect their joint replacement," he said.
2. KNEE AND HIP REPLACEMENTS SHOULD LAST LONGER THAN IN THE PAST
Materials used for the replacement joints -- metal, plastic and ceramic -- have gotten better and more durable so "we're hoping to get five to 20 years more than we got before -- maybe up to 30 or 40 years of wear," Capozzi said. The new generation of replacement joints hasn't been around long enough to know whether that's realistic, he said, but 20 to 30 years is a reasonable estimate.
Orthopedic surgeons use a variety of approaches in joint replacement procedures, D'Agostino said. "The thing about orthopedics is that there's more than one way to do these things," he said. "We do procedures differently because we're trained differently."
That means you have options. For instance, minimally invasive surgery is sometimes used instead of traditional surgery. The replacement joint can be cemented to the bone or designed so the natural and artificial parts fit together without cement. Ask how many surgeries are done at the hospital you're considering. A study in June in Arthritis & Rheumatism reported that serious complications occurred more often after hip and knee replacement surgery at hospitals that do relatively few surgeries.
"If the patient has any questions, they should always get a second or even a third opinion," D'Agostino said.
4. DON'T JUDGE YOUR RECOVERY BY OTHER PEOPLE'S
It may take you months to get back to normal after a joint replacement surgery, while your neighbor may be out speed-walking in a couple of weeks. "Don't panic as long as things are moving in the right direction," Capozzi said. "Recovery is highly variable."
Exercise helps the body adjust to the implants, he said, so "if patients are motivated and do the exercises with the therapist or at home, they'll do much better than those who don't do therapy."
In general, most people can return to work in four to six weeks and play sports by six weeks, he said, although recovery may take longer for those with other medical problems.
Medical problems such as tissue and bone damage have been reported in some people with metal-on-metal hip replacements. According to published studies, microscopic metal particles migrate into the body as the joint wears. In some instances, this has led to the all-metal joint being replaced with a metal-and-plastic model.
D'Agostino said that people with metal hips who have concerns can be tested to determine metal levels in their body. High levels and symptoms could lead to removal of an implant. But if you have high metal levels and no symptoms, it may be difficult to figure out what to do, he said. "The jury is still out on that."
This is the ninth installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: orthopedists
Dr. Scott Alpert
379 Oakwood Rd.
600 Northern Blvd.
Dr. James Capozzi
1300 Franklin Ave.
Dr. Richard J. D'Agostino
600 Northern Blvd.
Dr. David Dines
935 Northern Blvd.
Dr. Thomas Dowling
763 Larkfield Rd.
Dr. Samuel Kenan
300 Old Country Rd.
Dr. Craig Levitz
36 Lincoln Ave.
Dr. Ronald Lewis
Pediatric Orthopedics of LI
205 E. Main St.
Dr. Thomas Mauri
865 Northern Blvd.
Dr. Carlos Montero
2920 Hempstead Tpke.
Dr. Daniel Rich
585 Plandome Rd.
Dr. Nicholas Sgaglione
600 Northern Blvd.
Dr. Raymond Shebairo
1575 Hillside Ave.
Dr. Barry Simonson
825 Northern Blvd.
Dr. Jonathan Ticker
Island Orthopedics & Sports Medicine
Dr. Richard Tabershaw
375 E. Main St., Suite 1
How they were picked
Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.
Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Not every good physician makes the list. Rather, the list is a way for patients to get started on their search for the best medical professional. Newsday is not part of the selection process.
Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.
To see the whole list . . .
Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.