Whether his patients are older adults experiencing knee or hip pain, or sports aficionados experiencing joint pain that limits their athletic pursuits, Dr. Robert J. Avino, offers time- tested advice when they ask a simple question: when is it time for knee or hip replacement surgery?
“If their knee or hip is the first thing they think about in the morning and the last thing they think about when they go to bed – and if it’s knee or hip pain that’s preventing them from playing pickleball or golfing or getting down on the floor to play with their grandchildren – then it’s time to consider surgery,” says Dr. Avino, a board- certified orthopedic surgeon with Palm Beach Orthopaedic Institute who specializes in robotic joint replacement surgery at Jupiter Medical Center.
The path from consideration to a decision about surgery should be different for each patient, he emphasizes. Various factors – age, weight, overall health, type of pain/discomfort, underlying health conditions, and pursuit of non-surgical treatments – should be considered and explored before surgery.
First step: get the joint evaluated
Some patients delay seeing an orthopedist as long as possible, but “if you’re waiting, then you’re delaying treatment,” Dr. Avino points out. If joint pain has persisted for several months or is limiting favorite activities, he urges patients to meet with a board-certified orthopedic specialist.
Seeking an orthopedic consultation is reasonable if you have any type of pain that’s comes and goes – but doesn’t go completely away,” he says. First-line non-surgical treatments typically include:
- Physical therapy to strengthen the joint
- Easing off of strenuous or repetitive activities that worsen pain or joint stability
- Oral or topical anti-inflammatory medicines
- Weight loss
- Cortisone injections for knees (but not hips)
When is surgery the best option?
If a patient’s joint pain does not ease – or if it worsens – after three months of conservative treatment, then surgery might be warranted. Key factors influence the decision to replace an ailing joint with an artificial joint:
- Pain that remains or worsens after common activities (e.g., a round of golf, a game of pickleball/tennis, prolonged physical exertion)
- Lack of effectiveness of pain/anti-inflammatory medicines
- Appearance of groin pain or knee pain, especially if an X-ray detects bone-on bone conditions
Many times joint pain can be due to underlying tendonitis, inflamed soft tissue, or injuries that can be treated without surgery, says Dr. Avino.
Find a specialist for your specific diagnosis
Because orthopedic surgery encompasses up to nine different subspecialties, Dr. Avino urges patients to find a surgeon who specializes in joint replacement.
“When patients are seeing a board-certified, fellowship- trained surgeon, they’re seeing someone who spent an additional year training with experts and performing complex cases. These subspecialized surgeons might perform hundreds of knee or hip replacements a year,” he says. “Patients experience a different kind of care with potentially lower risks of complications and better outcomes.”
AUTHOR: Robert J. Avino M.D. is a board-certified and fellowship-trained adult hip and knee reconstruction surgeon at Palm Beach Orthopaedic Institute. Dr. Avino specializes in robotic-assisted hip and knee replacement using the minimally invasive direct anterior approach to hip replacement, across Palm Beach County in South Florida.
