It is only occasionally that arthritis is so severe it causes the hip to become fused, preventing movement. Pain has a useful protective function in the body. If we hurt ourselves the pain produced by the injury reminds us not to use (and further injure) the damaged area.
How does joint pain affect people?
People show “fear avoidance” behaviour, avoiding activities for fear they will increase their pain and worsen the situation. This can have a severe impact on quality of life. Often people tell me their condition is not really that painful, but on closer questioning, they have stopped all sporting or leisure activities due to pain. If you ask people to return to their activities, they find them too painful. Only then do they realise how much pain is actually affecting them.
Can orthopaedic surgery provide joint pain relief?
One of the great benefits of modern orthopaedics is we now have effective treatments for many very painful and disabling conditions. For example, a microdiscectomy is an effective treatment for ending sciatic pain. With a small incision, the fragment of disc causing the inflammation and irritation of the nerve is removed. This operation, which takes under an hour, and often only requires an overnight stay, gives dramatic relief in leg pain, and patients can return to most of their normal activities within a few weeks of surgery.
The area of joint replacement has achieved some of the most dramatic improvements. We now have effective replacements for most of the major joints in the body. Approaches to these operations have been refined over years, are generally muscle-sparing and allow rapid recovery to normal function with a minimal hospital stay of three to four days. Many associated complications that previously impacted joint replacement surgery have been addressed. Infection rates are now very low and effective coagulation therapy is available to avoid complications of deep vein thrombosis.
How can orthopaedic surgery be used to treat hip joint pain?
Previously, hip replacements were delayed as long as possible, so the new hip would last for the rest of the patient’s life. This approach can be problematic. Younger patients are more active than the elderly, often with children who want to be played with and active social lives and moderate intensity sports to be enjoyed, therefore, tend to modify their activities to avoid pain. If we can take pain away for these patients, they will lead much fuller and more rewarding lives.
Modifications in hip designs give a better range of movement and more closely resemble the patient’s own anatomy. Materials used in hip replacements have also changed to polyethylene inserts, which are much stronger, and the introduction of ceramics that show small amounts of wear and good long term durability.
Many patients worry about having a hip replacement, thinking their function will be less than before. But in the absence of pain, these joints function remarkably well. It is not uncommon for people to comment that they did not realise quite how much pain they were in, until its absence after surgery.
What are the benefits of orthopaedic surgery for joint pain?
Encouragingly, for the majority of people questioned in the research surgery had a positive effect in resolving many of their problems. Those who had knee surgery were rewarded with the best outcomes.
Although surgery was able to resolve some of the physical problems suffered by people, the greater impact was on quality of life with most sufferers experiencing enough relief to enable them to live a happy and fulfilling life afterwards. The musculoskeletal system is complex. Associated conditions and issues related to it are often difficult to diagnose, manage and treat.
Although surgery is not the solution to every orthopaedic issue – where there is a clinical outcome which can only be achieved through surgery, delaying surgery can often lead to a negative emotional and social impact. Even where surgery did not resolve the problem wholly, seeking consultant-led advice was seen as an avenue which should have been explored earlier, either to understand the options available and to be best placed to manage pain or long term solutions.
Recent developments in joint replacement surgery include minimal incisions; computer guided surgery; mobile bearings; gender specific knee replacements (more women have total knee replacements); retaining one of the cruciate ligaments during knee surgery and patient specific replacement joint replacements.
Continued research and technological advancements are helping surgeons reduce length of hospital stays and improve outcomes for patients. The research highlights how pain is more than a physical condition. The impact of living with pain has physical, emotional, social and psychological effects on each and every individual who lives with it. Understanding the impact of orthopaedic pain on quality of life enables both individuals and healthcare professionals to best evaluate the return on investment treatment might bring. Given the number of people in the UK living with some form of arthritis is estimated to be more than 10 million, the cost of pain to individuals, the work place and the healthcare sector cannot be underestimated.