Osteoarthritis: Managing without surgery
To help patients who want to “try everything” before considering joint replacement, turn to the STEPs approach.
Joint replacement: When or whether?
Patients who are considering joint replacement surgery or are interested in learning more about it need a realistic picture of what to expect. Explain that results are usually—but not always—very favorable. However, surgery often brings greater improvement in pain than in function, and recovery can be very strenuous and lengthy. Infection rates average 1%,34,35 and mortality rates are low. In a large study of veterans, the 30-day mortality rates after knee and hip arthroplasty were 0.6% and 0.7%, respectively,36 but thromboembolic complications may occur despite prophylaxis. Overall, 5% of those undergoing joint replacement surgery develop significant complications.34,35
Knowing what surgery entails and the difficult recovery required may help patients be more tolerant of their OA symptoms. Whatever treatment your patients opt for, empathy on your part will help, as well.
CORRESPONDENCE
James Crosby, MD, United Health Services, Wilson Family Medicine Residency, 40 Arch Street, Johnson City, NY 13790; James_Crosby@uhs.org
