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For months, Beverly Keel, 53, was able to ignore the pain at the top of her right leg that felt like a pulled groin muscle. But when she was sightseeing in France, in June of 2018, it went from bad to nail-biting.
"We did a lot of walking, and every day it got worse,” recalls Keel, chair of the Department of Recording Industry at Middle Tennessee State University near Nashville. “I was worried I wouldn't even make it through the airport.”
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Thankfully, Keel's agony was brief. Within two weeks of returning to the U.S., she had hip replacement surgery, spending just one night in the hospital. She was able to return to work using a cane in about three weeks.
Keel's experience is getting more common. Every year upward of 400,000 people in the U.S. have total or partial hip joint replacement, and another 600,000-plus get new knees, according to the American Academy of Orthopaedic Surgeons. These operations give them blessed relief from pain and, sometimes, a new lease on life.
"People are healthier later in life,” says Neil Cobelli, M.D., chair of orthopedic surgery at the Montefiore Health System in New York City. “They're living more active lifestyles for longer, so they don't want to be held back.” Cobelli predicts that 3 million joint replacement surgeries will be performed annually by the year 2030.
Outcomes for joint replacement are better than ever, thanks to more durable prostheses — the metal, ceramic and plastic components that replace the damaged parts of a joint. Most patients today can expect their implants to last 20 years or more.
But the real breakthroughs are taking place outside the OR. “What's changed more than anything is how we manage everything around the surgery — the anesthesia, postoperative pain and blood loss — rather than the actual procedure itself,” says Claudette M. Lajam, M.D., associate professor of orthopedics at NYU Langone Health and spokesperson for the American Academy of Orthopaedic Surgeons. “That's what allows us to get our patients out of the hospital quickly.”
Patients now receive drugs that keep blood loss to a minimum, reducing the need for a transfusion. Nerve blocks and spinal anesthetic numb patients’ limbs and avoid the risks and complications that can happen with general anesthesia. Physicians are also relying less on opioids, which can slow recovery, instead using nonnarcotic painkillers, nerve agents and muscle relaxants to knock back patients’ pain.
"This helps patients wake up a lot quicker,” explains P. Maxwell Courtney, an orthopedic surgeon at Thomas Jefferson University Hospital and Rothman Orthopaedic Institute in Philadelphia. “It helps them get up and participate in physical therapy the same day that they have surgery, and the data shows that it's a lot safer in terms of medical complications.”
Think you may be a candidate for a joint replacement? Here's what you need to know about each type of surgery.