Rehab, repair or replace – rethinking your options


We live in a fast-paced ‘quick fix’ society. Most of us become impatient when sitting in traffic, or waiting for our take away coffee. If our Wi-Fi takes longer than 20 seconds to load we become anxious.

If we happen to incur an injury that slows us down or stops us pursuing activities we enjoy we want a quick solution. As a result surgery has become a first point of call rather than a last resort. This coupled with advances in medical procedures and the speed of which procedures can be performed means it has become a viable way to resolve pain quickly. However for long-term benefits many in the health profession will argue surgery should always be a last resort. 

Surgery pros and cons

Recently, on their Insight program, SBS held an open forum of people who had all undergone joint surgery – all with varying degrees of satisfaction. This program reported that about a million orthopedic surgeries are performed each year and many of these are joint replacements – primarily hip and knee. Besides the cost of over 2 billion a year to our health system, the human cost was evident amongst this panel.

One person had undergone 11 knee operations by the age of 31, with his first operation at 18. As a footballer he claimed the “arthroscopies were like a placebo – I was able to slow down and became pretty nonchalant about surgery”. It became just par for the course if he wanted to play football. As one member of the audience stated “it is a great option if it works, but be warned if it doesn’t there in no going back” (no pun intended).

Professor Ian Harris, an orthopedic surgeon, who was part of the audience, stressed that the need for many commonly performed operations is not always obvious or the only method available.  In fact, other interventions such as physiotherapy, proper exercise programs and weight loss can if undertaken diligently, save you from the operating theatre. However, they do take considerable time and commitment before results are evident, and most of us are time poor.

On the other hand, a panelist on the program explained that she had done everything including physiotherapy and chiropractic treatment but nothing had worked…surgery was a final resort and relieved her of her pain.

Obviously the best approach is to try less invasive more conservative therapies and if they don’t work, after a reasonable amount of time then surgery may be your best option.

Lets look at the big picture

Joint pain has many causes – ranging from injury from a fall or sport to osteoarthritis or inflammatory joint disease.

Regardless of the how your injured has come about your overall goal should always be to preserve your joints as much as possible particularly if you are young and active. With this in mind it is also important to consider the following factors and where you are in relation to all the below variables. 

Age – preservation techniques are definitely more effective for the young but should not be discounted for those patients who are older. If you are young and active  try to preserve your joint. If you are older and are showing signs of degeneration, rehab without surgery may still be possible.

Weight – every extra kilo increases strain on your joints, a weight loss program that incorporates low impact exercise appropriate for your condition is vital. Stationery cycling, gentle weights, short walks, swimming and the exercises your physiotherapist gives you are vital. Obviously, these can be as boring as musical scales but they are the only way to become a strong member of the orchestra again. 

Lifestyle – individual lifestyle will also determine your final decison. Clearly if you are a construction worker you may need to get your back pain sorted faster than someone who is working in an office.

Less invasive options

Injections – can reduce inflammation in the lining of the joints and are effective for many sufferers. They sometimes wear off and two or three injections may be required.

Stem cell injections –  a relatively new technique and involves collecting tissue from one part of the body and transplanting that tissue to the injured area.  These cells are know as progenitor cells and can form new tissue including bone or cartilage. More studies need to be done in this area, but it is likely they will become invaluable therapies.

Cartilage transplant cartilage can be grown and placed in the damaged area this will encourage the bone in the joint to grow more cartilage. A good method for hip and knees but not so good for shoulders and longevity studies need to be done. 

Partial Joint Replacement – if  damage is limited to a small part of the joint the surgeon can preserve part of the joint or single compartments and use smaller artificial parts to replace damaged parts. This is used with caution as it does not prevent degeneration in other joint compartments and so does not last as long as a total joint replacement.

Are you surgery fit?

If you have exhausted all options and you are still in pain, surgery is most likely your best option. Joint replacement surgery is safe and very effective and if you have weighed up all your options it is unlikely you will regret your decision. In the end staying active is very important for your physical and mental health and needs to be a priority.

It is always best to have a team approach and by this I mean that it is best to discuss with your physiotherapist and your surgeon. Any good surgeon and physiotherapist will not launch into surgery as a first resort. Your team should help you make the best and most appropriate decision that will enable you to preserve your joints or ensure you get back to enjoying your lifestyle pain free for as long as possible, regardless of your age or level of activity.

To gain the most effective long-term benefits, there are no quick fixes. To achieve the best outcome you need to commit to a long term rehabilitation regime.

At Janet Brandt-Sarif Physiotherapy they can develop a specialised program that best suits your individual requirements. They will prescribe a graduated exercise regime that targets your specific problems and helps you return to your activity and maintain good health at the same time. They also hold group classes for post-surgery recovery.

Always remember as Picasso remarked years before joint surgery was thought of…

“It takes a long time to become (and feel) young”.

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