Deciding on Joint Replacement Surgery: Advances in pain management and surgical technology are making the decision easier
By Daniel Sage, MD

People have always weighed the benefits and risks of joint replacement surgery before deciding whether to undergo the procedure. Will the pain associated with surgery and recovery outweigh the pain they’re living with every day? For some people, the answer is a resounding yes. A deteriorating knee or hip joint can make every step excruciating, taking a lot of the joy out of life. But others hang on for as long as they can, hoping to avoid what they think may be a very painful experience.

Over the last several years, dramatic changes in pain management for joint replacement surgery, improvements to the surgical procedure itself, and new technology designed to enhance accuracy and precision are making joint replacement surgery a less difficult choice.

Today, we attack pain from a variety of angles, beginning with the anesthesia used during surgery and on to a full arsenal of pain management modalities including intra-articular injections, nerve blocks, IV acetaminophen, anti-inflammatories and other non-narcotic medications. All of these options mean that patients, on average, require less narcotic medications.

Joint replacement surgery is still painful - I don’t want to mislead anyone on this point. But generally, people are not suffering like they once did. Good pain management enables patients to get out of bed and start moving their new hip or knee – often on the same day as surgery. Movement is an essential first step to recovering, and better pain management not only makes the experience a lot more comfortable, it’s also helping to speed recoveries.

The advent of more reliable cementless knee implants over the last decade represents another big improvement in the surgical procedure. Traditionally, the gold standard in knee replacement surgery was the use of cement to bond the implant to the bone. Yet, cement could break down over a period of time, sometimes requiring additional surgery to revise the implant years later. Today, cementless knee implants are performing very well – with growing evidence to support its use in many patients. The great advantage to this technique is that the bone will grow into the implant and become part of the body. It also eliminates a potential cause of revision down the line.

In my opinion, one of the most encouraging advancements in joint replacement surgery is robotic technology, which supports greater accuracy in bone cuts and more precise placement of the implant. Before surgery, a CT scan enables surgeons to plan how much bone will be removed to make way for the new implant. The image also guides the exact placement of the new joint. During surgery, the robotic arm makes sure that this plan is followed exactly, allowing us to consistently give a patient a perfectly balanced and aligned knee replacement.

Robotics in joint replacement surgery is relatively new and definitive studies to support its use are not yet available. However, early literature suggests improved pain scores, physical function scores, and overall patient satisfaction. Robotics also enable surgeons to accurately place implants in patients who are considered outliers – meaning the alignment of their legs fall outside of what is considered average.

Orthopedic surgeons diagnose when a patient reaches the point when joint replacement becomes necessary. But only patients can decide when they’re ready. Hopefully, it’s an easier choice these days. And waiting on the other side of surgery is a better quality of life.

Dr. Sage is an orthopaedic surgeon at Berkshire Orthopaedic Associates, an affiliate of Berkshire Health Systems