Before looking at some thoughts about why joint pain doesn’t have to be an inevitable part of life, especially as we grow older, a very brief anatomy lesson might be helpful: a joint is the area where two bone ends meet to provide motion to a body part. Joints are primarily composed of bones, separated by cartilage that provides cushioning, and ligaments that attach bone-to-bone around the joint.
Sounds simple enough, but the problem comes when an injury or a chronic condition like arthritis brings on various levels of discomfort or pain to the joint. And when that happens we realize very quickly how often we use our joints in daily activities.
In this informative question and answer session, orthopaedic surgeon, Tyler C. Wind, MD, provides some comforting thoughts for anyone with sore joints. Dr. Wind, a native of Tappahannock, is with the Northern Neck Bone & Joint Center. He has specialized training in joint replacement as well as sports medicine, hand surgery and the treatment of complex fractures. In addition, he has performed thousands of minimally invasive arthroscopic and joint replacement procedures of the knee, hip, shoulder and ankle.
Q. Is surgery the best option for joint pain?
A. Surgical procedures, including joint replacement, can change lives for the better. At the same time I would say, ‘don’t have surgery unless you really need it.’ The best option for treatment is always going to be what works best for you on an individual basis. Too often, I’ve seen the fear of surgery keep people from talking with a specialist about joint pain. That’s unfortunate because there are a number of things you can do before or instead of surgery.
For example, physical therapy, injections, medications, exercise, and lifestyle changes are all effective in treating joint pain. I was fortunate to train with one of the top orthopaedic surgeons in the country. Although helping people through surgical procedures was central to his work, he also believed that surgery was an option, not the option. He instilled that thought in me and it’s why I think you should consider surgery only after you’ve tried non-operative treatments.
Q. Under what conditions is surgery advised?
A. Again, we’re talking about individual choice. Some physicians say wait until you’ve tried everything else and can’t tolerate the pain any longer. Others may advise you to get surgery as soon as possible so you can enjoy the benefits longer. I tend to come down somewhere in the middle. If you can no longer control pain to a reasonable level or the joint problem is negatively affecting your lifestyle, surgery should be considered. In any case, we are rarely, if ever, talking about a life or death decision. So when patients ask me if they need a joint replacement I generally say, “You tell me.”
Q. Should people wait for new advancements in joint replacement?
A. The first joint surgeries and even the first true joint replacements were performed decades ago. Since then, there has been a constant evolution in the field that’s seen significant advances in surgical techniques. There has also been notable progress in the function and durability of the materials used in orthopaedic implants.
All of these advancements enable me to carry out minimally invasive procedures with smaller incisions that result in less pain and considerably faster recovery times. With regard to recovery, I also use a drug called tranexamic acid that helps prevent excessive blood loss, so patients have higher blood count levels and, as a result, feel better after surgery.
Another advancement that’s making a difference is computer-assisted surgery. By using computer guidance in knee replacement procedures, I’m able to align bones and joint implants with a far higher degree of accuracy. The objective is to enhance the specialists’ existing surgical skill with the precision of computer technology. There’s no question that future developments will continue the joint surgery evolution. But while it’s never a good time for joint pain, the present is a very good time to do something about it.
Q: How long are you out of action if you opt for surgery?
A. The quick answer is that recovery is a lot faster than you might think. For example, after total knee replacement, we use what we call Rapid Rehab Protocol to get people up and moving the same day. Our average length of stay for joint implants is one to two days, which is about half of the national average. After intensive physical therapy and pain management during the short inpatient time, most patients get rehab and nursing visits at home for a couple of weeks before transitioning to outpatient physical therapy. And I would add that with having patients go through an educational program we call “Joint University,” they have a good idea about what to expect at every stage.