Mar 11, 2015

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Interviewer: You've been considering a total joint replacement whether it be a hip or a knee and you're wondering if it's right for you. In this series of podcasts, we're not only going to talk about that, but if you decide to have the procedure, we'll give you some insight as to what you can expect before, during, and after.

In this very first podcast, we want to cover is a total joint replacement right for you? So are you a likely candidate for it? We want to make sure that you understand your condition. Why you should talk to family members, which is an important component of it. Plus, also, have you considered other more conservative measures before considering a joint replacement.

Dr. Chris Pelt is a joint replacement expert at University of Utah Health Cares Orthopedic Center. First of all, what types of joint problems can a joint replacement improve, because it doesn't fix everything.

Dr. Pelt: Joint replacement is designed to alleviate pain associated with arthritis of the hip or knee. It's a surgery that's usually performed after people have tried other conservative methods of reducing pain, and after pain interferes with ability to perform the things that they need to do, enjoy doing, and actually their quality of life.

Interviewer: Now who are some people that might not be good candidates?

Dr. Pelt: Well, anybody may be a candidate, but there are definitely people that may be at higher risk for complications or that may not be an ideal candidate to undergo surgery at that stage of their life. Certain high risk people might be people with morbid obesity or increased body weight. That increases their risk for decreased lifespan of the joint. It also increases their risks for complications like infections and other things. Similarly, patients with diabetes need to have well controlled diabetes. Smokers need to stop smoking before they can be a candidate for joint replacement, because it increases their risk of infections, poor wound healing, and even pain afterwards. So these are a few areas that we can perhaps medically optimize before.

We also want to ensure that the patient is the right candidate for joint replacement, because their arthritis is advanced enough on an x-ray. That means bone on bone type of arthritis. And that's something that you can see that with the joint replacement specialist or your primary care doctor even with an x-ray. And also patients that have gone through previous conservative methods trying to avoid surgery. We don't like to perform a joint replacement surgery on everybody simply because it may not last forever.

So if you're really young, there's a good chance that we're going to try to maximize the life of your native joints so that you can live longer and hopefully maintain your own joint before needing a joint replacement. Decreasing your need for potential future revisions of a joint replacement when you eventually do have that.

Interviewer: Yeah, so this sounds like some good common guidelines, but I think it's important to contact a professional such as yourself to maybe help somebody make that decision.

Dr. Pelt: Absolutely. Most of our patients will usually have gone through their primary care doctor or even non operative orthopedic specialist, physiciatrist, sports medicine doctors through some conservative methods before they reach an arthroplasty surgeon. And what that does is allow them to have an optimization of that conservative treatment before a surgery is offered.

Interviewer: Do you have other resources that somebody may want to consult?

Dr. Pelt: Absolutely. We have the University of Utah website where if you go to the Health Sciences website, and the Department of Orthopedics, our joint replacement center. It has a great resource of information about what is hip and knee replacement, what are hip and knee arthritis, what are my treatment options. It's a great starting point that allows you to start to get a little bit of information about this as well as the opportunity for you to seek an appointment and meet the providers. There's good biographies on the website so you can learn about the providers and even make an appointment right there if you want.

Interviewer: And this isn't a decision I will necessary make on my own. I guess what I'm getting at is if I decided maybe this replacement is right for me, I've already talked to somebody extensively about it at this point.

Dr. Pelt: Yeah, some people will have gone through their primary care doctor and other non operative doctors. Some people just know they have arthritis, have talked to their family. I think it's really important to realize this is a big decision. It's a very big surgery. You want to take the time to talk to your families, talk to your care providers, and meet with your surgeons if it's ultimately felt that joint replacement is right for you.

In the end, when we've tried all those conservative treatments, avoiding the surgery, the time to consider doing a joint replacement is, when pain is not being controlled with those other things and now pain as primarily pain interferes with three components of your life. It's the things you need to do and those are the things like going to work, caring for yourself, caring for your family, caring for your home. Those day to day activities of daily living.

The second aspect of life that is interfered with pain is the activities of leisure and enjoyment. Those things you like to do whether it's gardening, skiing, hiking, walking, riding bicycles. Any of those types of activities that you want to be doing more of, but pain is prohibiting you from doing that.

And the third component is the quality of life. It's your ability to be happy. One of my patients told me it's their ability to smile everyday. When pain is starting to impact your life to such a point that you're grumpy and you're not smiling, that's a good indicator that it's time to talk to somebody about this.

Interviewer: Coming up in a couple of more the podcast we're going to cover specifically if you're considering a knee or hip replacement, the similarities and the differences. Then also in the series of podcasts, if you decide that this is something that you want to do we'll give you some information as to how you can prepare for your surgery and what to expect after

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