22 Apr What to do when your knee or hip replacement has been pushed back
Has your knee or hip replacement been pushed back? Have you been told you have ‘wear and tear’ and there’s not much you can do about it?
Here’s the facts:
With Australia’s ageing population continuing to grow and improving health care services keeping Australians ticking on for longer it’s no wonder that joint replacements are growing in number too. In 2013 there were 42,920 knee replacements and 25,945 hip replacement surgeries in Australia (6). According to a study conducted by Monash University, these numbers are predicted to rise by over 200% by 2030 with knee procedures predicted to reach over 161,000! (6) As you can tell by these numbers, that makes total knee replacements one of the most common and widely prescribed elective surgeries.
But old age and ‘wear and tear’ go hand in hand and there’s nothing we can do about it, right? Well, maybe not so much.
Pain and mobility deficits caused by osteoarthritis is the cause for 98% of knee replacements in Australia and is a very common disease that affects 1 in 12 Australians (4). To get to the root of the problem we need to look at osteoarthritis of the knee and hip joints and how this can be both managed and prevented. Exercise is one of the most widely accepted, non-operative treatments for osteoarthritis. Arthritis Australia reports that “regular exercise is one of the most important treatments for arthritis; it helps to reduce pain and maintain general health” and goes further to recommend low-impact activities such as swimming, cycling, walking and strengthening exercises (2). These exercises aim to strengthen both the muscles and stabilising structures around the affected joint to reduce the impact loading, improve mobility and reduce pain (2). Particularly in osteoarthritis of the knee, weakness in the quadriceps muscle contributes to joint instability and functional disability (3) in several ways and strengthening of the quadriceps should be the goal of any exercise intervention.
One strengthening exercise for the quadriceps is the terminal knee extension shown below:
Another primary preventive strategy for osteoarthritis is weight loss. People who are overweight or suffer from obesity are at higher risk of the osteoarthritis and it being both symptomatic and progressing more rapidly (3). Various studies have linked this to constant stress and load being placed on weight bearing joints and increased stress on cartilage. Weight loss in these studies was related to an improvement in symptoms of knee pain and overall disability reduction (3). Another study estimated that 43% of knee osteoarthritis and 53% of knee replacements in Australia are due to obesity which highlights the need for weight loss to be a goal in treatment of osteoarthritis (4).
Furthermore, exercise programs, especially from an Exercise Physiologist, will aim to address patients holistically as a vast majority of people with osteoarthritis have several other comorbidities. This can include screening to look at the joints above and below the affected joint, reducing risk of cardiovascular disease or improvement in blood sugar levels related to diabetes.
Australian Guidelines for management of knee and hip osteoarthritis places a large emphasis on lifestyle and behavioural interventions such as weight loss and exercise regimes (5). Joint replacement surgery is a successful and effective intervention for people with severe osteoarthritis but is recommended to proceed only after conservative methods have proved unsuccessful for selective patients (4). Unfortunately, we often see this as an overprescribed treatment option which costs the patient and the healthcare system a lot of money every year. So much so that it is projected to cost the Australian healthcare system $5.32 billion in 2030! (1)
So instead of accepting the ‘wear and tear’ that is common with ageing, instead strengthen and support the joints as you would support a historic building; with supporting beams and trusses that are your muscles!
Ackerman, I., Bohensky, M., Zomer, E., Tacey, M., Gorelik, A., Brand, C. and de Steiger, R., 2019. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskeletal Disorders, 20(1).
Arthritis Australia. 2020. Knees — Arthritis Australia. [online] Available at: <https://arthritisaustralia.com.au/what-is-arthritis/areas-of-the-body/knees/> [Accessed 20 April 2020].
Basedow, M., Williams, H., Shanahan, E., Runciman, W. and Esterman, A., 2015. Australian GP management of osteoarthritis following the release of the RACGP guideline for the non-surgical management of hip and knee osteoarthritis. BMC Research Notes, 8(1).
Safetyandquality.gov.au. 2020. [online] Available at: <https://www.safetyandquality.gov.au/sites/default/files/migrated/4.1-Knee-replacement.pdf> [Accessed 20 April 2020].
Www1.racgp.org.au. 2020. RACGP – Updated Osteoarthritis Guideline Designed To Reduce Unnecessary Imaging And Surgery. [online] Available at: <https://www1.racgp.org.au/newsgp/racgp/updated-osteoarthritis-guideline-designed-to-reduc> [Accessed 20 April 2020].
Fratantoni, M., 2020. Knee And Hip Joint Replacements Set To Rise By More Than 200 Per Cent | The New Daily. [online] The New Daily. Available at: <https://thenewdaily.com.au/life/wellbeing/2019/02/25/joint-replacements-to-rise-200pc/> [Accessed 20 April 2020].