Faced with the choice of living with intense pain or experiencing the disruption of major surgery, many patients become paralyzed, researching and considering their options for months or even years. Many reach a tipping point when their quality of life has suffered enough that surgery seems the easier option.
Surgery is often the last resort
"It should be when you have failed conservative treatment, when your lifestyle is being impaired, and when the pain is such that it's occurring not only when you move but even when at rest and at night," says Bernard Rubin, DO, director of the rheumatology fellowship at the University of North Texas Health Science Center in Fort Worth.
"Patients have to feel that they've exhausted other available options and those available options are simply not giving them enough relief," agrees Sharon Kolasinski, MD, interim director of the rheumatology division at the University of Pennsylvania. "There's no one point, people reach that point at different times and at different ages."
It's up to you
Most physicians, Dr. Kolasinski says, wait for the patient to express interest in surgery. That signals that the patient is ready for the long road ahead.
"You're much more likely to have a successful outcome, in terms of the control of pain and good function, in a patient who's on the same page as you," says Dr. Kolasinski, "Someone who says 'I embrace this, I understand I have to participate in the rehab, I have to put some energy in this.'"
An athlete takes his time, then makes a dramatic choice
Glenn, 54, from Chappaqua, N.Y., was a dedicated runner. Then he suffered intense, stabbing pain in his knee that turned out to be arthritis in the hip. (Nerves can project pain that originates in the hip down the thigh to the knee.)
It turned out that cartilage in his left hip was 75% degenerated, and in the right it was "all gone." A hip replacement was the logical option.
But Glenn took his time deciding. "I kept thinking, 'Is the pain really so bad?' Yet at cocktail parties, the standing was agonizing. I couldn't walk across town anymore. I couldn't wash my feet in the showerhip patients have real trouble reaching their ankles and their feet. It was degrading in so many ways. I felt about 90 years old. And the pain woke me up every night three or four times."
According to Dr. Rubin's criteriawhich includes pain even at restit was probably time. But it wasn't until Glenn's left hip became painful, almost a year later, that he faced up to surgery.
Aware of cost, recuperation time, and the 15- to 20-year life span for replacement joints, Glenn opted for the extreme choice of having both done at once. "I'm vigorous enough," says Glenn. "It's heavy-duty, and it really tears you up, but somebody my age, you can get them both done at once."
A decade leading up to an operation
For Charles, 66, of Grantham, N.H., it took 10 years to take the leap.
"It took a long time for me to really be aware of it. I spend a lot of time driving for my job, and it was getting more difficult for me to get in and out of the car," says Charles. "I had pain, but it wasn't severe. That's why I never went to the doctor. I just figured I had a hockey injury or something that was maybe flaring up."
His mother had some arthritis, and his paternal grandmother had severe arthritis, but Charles still didn't think he could be suffering from it himself.
"I think my male ego kind of prevented me from accepting that. I didn't really accept it until I went in and had the X-rays."
His doctor took the patient-knows-best approach. "He said 'I could do it now, but you will tell me when you want it done'," says Charles. And he finally did, 18 months later.