Jeff was my roommate in medical school and later trained at one of the top orthopedic programs in the USA. He was a better student than I was. As kids, we climbed, weight lifted, and flew hang gliders together. We are now old dogs, so we compared injuries, and I have had more. Our dialog will amuse you. Here are a few other things we discussed:

• Jeff says that stem cell injections work poorly for arthritis.
• Steroid injections and cartilage removals create joint destruction and lead to the big surgery sooner. Both are a bad idea.
• The operation time for joint replacements is usually short—between an hour and two hours.
• Anticoagulation is used for months after some joint replacements.
• Some people can use joints that seem worn out, according to the X-rays. Since these surgeries are done for symptoms, you do not need the procedure if you have little pain. Jeff said that if you have no joint space, most people get better with an implant.
• Checking the urine and the teeth for infection before joint replacement is prudent because infections are life-altering and can spread from sources like these. Dental “spiral CT scans” can be used to be sure patients do not have hidden abscesses of the mouth.

I studied this subject when considering what to do with my sore shoulders, and I thought my listeners would like more information. Another factoid: RFK, Jr. told me that he had all six of his major joints--his hips, shoulders, and both knees--replaced or revised. All are working well. 

The general principle is that you never consider these surgeries unless you have significant pain and are taking painkillers to sleep at night. If your discomfort is tolerable, you do not want to endure the risk, hassles, and recovery of a joint replacement or other surgery for orthopedic problems. Even if your X-rays look terrible, sensible surgeons do not recommend reconstructions or joint replacements when symptoms are modest. Many situations will improve if you are patient and carefully rehabilitate yourself.

You can investigate your case by getting x-rays and seeing the orthopedist if you have chronic, moderate pain. Find out who has the most experience with the procedure you might need and see what they think. 

The hip replacement procedure won an award as the safest and most effective surgery of the 20th century. This is not entirely true; cataract surgery is better. Hip replacements rarely have complications, but if they get infected, it is life-altering. On the other hand, cataract surgery has almost no problems in experienced hands and consistently improves vision. Some newer lenses can help you see near and far, like bifocals.

Although knees are done more commonly, shoulder replacements are the second most predictable total joint surgeries after hips. In experienced hands, however, shoulders have excellent results with proper rehabilitation. If your tissues and body are reasonably healthy before the surgery, your chances of a perfect outcome are high. I had little pain and took no opioid painkillers after mine.

My friends have all had great results and needed no pain drugs after their knee replacement recoveries. However, published reviews of this surgery show that up to 50% of patients still require painkillers following the surgery. These also get infected more often than hips or shoulders. The factors that predict excellent results are good health, bone quality, and the surgeon's skill. Skill is directly related to the number of cases done—experience. Always ask your surgeon how many like yours he has performed.

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