Agony In the Bones
Arthritis is crippling more people, but there are nine key ways to beat the pain
9. SURGERY AND REPLACEMENT
" I tell my patients, 'when you're sick and tired of the conservative stuff and it doesn't work, it's time to think about surgery,' " says rheumatologist Couri. For OA, one option is an osteotomy, in which a surgeon cuts away part of the bone to relieve pressure on damaged cartilage and shift weight to a healthier spot. People with RA have their own set of operations, including synovectomy, to remove inflamed tissue that surrounds the joint. Simply scraping and cleaning out the joint, or arthroscopic surgery, has been on the decline since a recent article in the New England Journal of Medicine showed a sham surgery relieved pain and improved function just as well.
Then there's the big one: joint replacement. It's extremely popular both with patients and with doctors, and for good reason--it works. "It's one of the most successful operations in the history of medicine," says Lester Borden, head of adult reconstructive orthopedic surgery at the Cleveland Clinic. In recent years, implants have become much more durable and now may last for 30 years, and surgeons have figured out how to insert them using smaller incisions, reducing recovery time. But it's still not to be taken lightly.
Recovery can be painful and involve many days in the hospital or a rehab facility. But for Rich Kase, after 15 years of drugs and injections and smaller knee surgeries, "I wanted it. I wanted a new lease on life. I could only walk about 50 yards, the pain was constant, and my orthopedist said I had the joints of an 80-year-old." He was 50 at the time and opted for a double-knee replacement. "My surgeon said to do them both at the same time, because I'd only have to go through rehab and recovery once. And it's excruciating. It's tough surgery. I wouldn't want to do it twice. The next morning they made me get up and out of bed, and I'd say the pain was a 9 or a 10, even though I had a morphine drip in."
Road to rehab. Kase went home and had physical therapy there for three weeks, followed by three more weeks at the therapist's office. In a month he was back at work and soon after that, back on the golf course. "It's been phenomenal. I walk the course, going down hills the right way. I can go on vacation and bike 10 miles with no pain. I had to get my pants lengthened because I'm taller and straighter. I do, however, use the surgery as an excuse not to kneel in church."
Susan Thompson, a 72-year-old retired veterinarian in Sag Harbor, N.Y., says she is conservative by nature, which is why she is holding off on hip replacement for now. She's got osteoarthritis in that joint and rheumatoid arthritis elsewhere and is taking Enbrel and other medications to keep her pain in check. "They recommend surgery to me all the time, but the idea of the recuperation really throws me," she says. "You never know how long it will take, how long you'll be out of your home." She can still do housework and get around and is happy to wait until she absolutely needs surgery. "After all, it's not like I'm resuming a career in the dance," she says.
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