Joint replacement: Why it’s the best option for end-stage arthritis

Jun 03, 2021
The most common joints replaced are the knees (pictured) and the hips. Source: Getty

It is estimated that about 2.2 million Australians (or 9.3 per cent) suffer some form of osteoarthritis. This affects 12 per cent of females and just under 7 per cent of males.

The common joints affected are the hip, knees, shoulders and ankles. The small joints in the hands and feet — along with the neck and lumbar spine — are also very common sites for this significant, chronic complaint.

Although there are many supportive therapies — the most well studied and effective being exercise and weight loss — the gold standard for end-stage arthritis is joint replacement, with the most common joints replaced being the hips and the knees.

About 12 months ago, I underwent total knee replacement of my right knee because of continual sport from the age of five to 52. After 12 years of trying many different therapies, including stem-cell treatments on two occasions and PRP therapy multiple times, with minor benefits from either, I had suffered enough with pain and difficulty functioning. Over the past decade, I have been taking a vast array of natural therapies along with intermittent non-steroidal anti-inflammatory drugs when the pain was too much to bear, so I decided to have my knee replaced.

Although the first month after the operation was very uncomfortable, I was very compliant with physiotherapy. I initially required heavy pain killers but quickly weaned off these after a month. I continue my program of three to five hours of exercise a week with about 2/3 cardio and 1/3 resistance and strength training to maintain upper-body and lower-body strength. I’m delighted to say that the operation has been a great success.

The vast majority of us over 60 know a relative, friend or have personally had one of our joints replaced, typically the hip or the knee — as mentioned. The ankle is the poor cousin to the hip and knee, receiving little attention in the medical media. A recent study published in May in the Journal of Bone and Joint Surgery from the University of Washington compared a total ankle replacement with the more standard ankle fusion as a therapy for people with severe ankle arthritis.

The study examined 517 patients, 414 who elected to have total ankle replacement (known as arthroplasty) versus 103 who decided to undergo ankle fusion (known as arthrodesis). All the surgeons involved in the study had extensive experience in hip, knee and ankle surgery.

The patients were followed for four years and although both operations were successful, the total ankle replacement outperformed the ankle fusion in almost all parameters. The patients who had the total ankle replacement reported better function in aspects of daily living and sports along with a better general quality of life. Their pain improvement scores were superior, and 78 per cent who underwent total ankle replacement were completely satisfied versus 60 per cent who had the ankle fusion. There was also less need for re-operation with 9 per cent in the total ankle replacement group and close to 18 per cent in the ankle fusion group.

Therefore, if you are struggling with your ankle pain and it has been demonstrated that you have severe bone-on-bone arthritis in the ankle, talk to your surgeon about a total ankle replacement, which appears to have a better long-term result than the standard ankle fusion. Most importantly, do not suffer in silence, because there is so much that can be offered with any form of arthritis.

Want to read more health articles by our health expert Dr Ross Walker? Head here.

IMPORTANT LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your personal health requirements or existing medical conditions. That means it’s not personalised health advice and shouldn’t be relied upon as if it is. Before making a health-related decision, you should work out if the info is appropriate for your situation and get professional medical advice.

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