Replacement Parts
Laura Olinger, founder of vintage moves
In many elder fitness classes I’ve taught hundreds in various stages of avoiding, delaying or recovering from hip and knee replacements. Often they share their situation with me. Sometimes they don’t share until I inquire about their posture, difficulty with certain exercises or overt wincing in pain.
My role is to support their strength and cardiovascular conditioning. I am also often a cheerleader, providing moral support. I do not carry a medical license nor medical opinion, and offer an opinion from the perspective of a fitness instructor who has watched many participants (and my husband) go through the process.
The primary questions are: If? Which Doctor? and When?
If? Do I really need that joint replacement?.
Are you experiencing pain or extreme discomfort when using the joint the way you want and need to use it? This point can refer to a simple “Activity of Daily Living” like going to the restroom, up stairs, putting on your socks, or cutting your toenails. Or, it can be about riding your bike, hiking, walking, skiing, golfing…participating in your favorite sports and activities. Being truthful to yourself is imperative when answering this question.
Second, Does a qualified medical Doctor, with visual analysis on a computer screen, recommend a new joint? And, I always encourage a 2nd or 3rd opinion! This is still under the IF? question.
It is ABSOLUTELY OK to get a 2nd or 3rd opinion. In fact, I highly recommend it. Doctors have different perspectives and opinions. Take advantage of their expertise for your peace of mind.
It is ABSOLUTELY OK to get a 2nd or 3rd opinion. YES, I MEANT TO SAY THAT TWICE.
Which Doctor? If you’ve now talked to 2-4 Doctors, know that you really do get to choose who does your surgery. Insurance is likely to be a factor and your choice may or may not be the same doctor your friend, neighbor, or spouse chose! Recommendations are good, and you still may choose differently. Feeling “comfortable” can be broken down into your own criteria, and here are a few we look at: training, credentials, experience, number of similar surgeries completed, and success rates. In our family, bedside manner is optional as we go for technical excellence and seek comfort elsewhere. The bottom line is that you are not stuck with that first doctor — go ask questions, generate your criteria, ask for recommendations, take a trusted friend or family-member to your appointments — be an educated consumer and choose wisely.
I’ve also seen people opt to not get the replacement due to lack of confidence with their doctor, and/or when they haven’t yet reached maximum pain level 24/7. …don’t wait that long! It is easy for the brain to bounce back and forth between these two without taking action. When the joint feels less painful the issue of not feeling great confidence in your doctor isn’t that important and can be ignored. When the joint is more painful you’ll feel more concerned about the lack of confidence in your doctor, and push through the pain in heightened stress from the pain but not in your best decision-making frame of mind. …see how one can get stuck there? Or, make a decision that isn’t your best choice?
When? My husband’s Doctor’s answer was something to the effect of, “ You’ll know when you’re ready.” As a man who spent his career in the medical field and who had consulted several doctors, he scheduled his surgery for full hip replacement after having successfully delayed it once (18 months) and eventually realizing his life and simple activities like putting on his socks were altered and compromised by pain, beyond discomfort. He was still participating in spinning classes regularly and maintained healthy, strong muscles in his hips and legs going into the surgery. I applaud his process and his recovery was quick!
I’ve also seen class participants wince in pain as they attempt exercise while dealing with so much joint pain that the exercise can’t actually be accomplished in alignment and form that retains the intention or value of the exercise. All other risks aside, I want them to have that surgery when -
The muscles of the joint are still active and strong. Waiting until movement itself is compromised by muscular atrophy makes recovery longer and more frustrating.
The pain BEGINS causing a change in vertical alignment of the body - or BEFORE THIS HAPPENS! A hip with no cartilage will often cause the upper body to lean forward at the hip crease, and the foot (whole leg actually) to angle outward. A knee will likely stay slightly bent or torqued with every step, and cause an overworked ankle compensating for the less mobile knee. All of these compensations are “untraining your brain” from knowing how to move, and are stressing other joints. Get it done before this happens!
Another real story — An aqua fitness participant in her early 70’s went the distance with attempts to avoid both hip replacements, including stem cell therapy. She still came to class and I could see her participation becoming more uncomfortable. When it was finally clear that stem cells were not going to fix her hips she went for it — replaced 2 hips 3 months apart. Most of her recovery was swift and her Physical Therapist was amazed at how she bounced back. Participating in my aqua fitness classes before surgery and after graduating from PT got lots of credit. AND STILL — It took her a full 2 years to regain good strong vertical alignment and a regular gait when walking! She described the experience as having forgotten HOW to walk upright while compensating and adjusting for the pain.
Another scenario that I can’t leave out is that life deteriorates with the advancing use of pain killers. Addiction issues aside, they are hard on your body and cause any number of discomforts in addition to making the pain only somewhat tolerable. If you’re taking pain killers daily, I hope you’ve also already scheduled surgery.
Lastly, pain is exhausting and can consume a person’s entire focus and energy resources leaving them exhausted and not enjoying life.
Given the medical advancements and ease of replacing hips and knees, my preference is to see class participants get the joint replaced, do their Physical Therapy, and return to their regular exercise regimen as quickly as possible, without rushing it. (I’ll talk about “rushing it” in a separate blog.)