YOU

DON’T HAVE
TO LIVE
WITH
JOINT PAIN
A PATIENT’S GUIDE
TO THE CAUSES AND TREATMENT
OF JOINT PAIN
You Don’t Have To Live With Joint Pain!
our joints are involved in almost every activity you do.
Y Simple movements such as walking, bending, and turning
require the use of your hip and knee joints. Normally, all
parts of these joints work together and the
joint moves easily and without pain. But
when the joint becomes diseased or
injured, the resulting pain can severely
limit your ability to move and work.

Whether you are considering a total joint

replacement, or are just beginning to
explore available treatments, this booklet is
for you. It will help you understand the
causes of joint pain and treatment options.
Most importantly, it will give you hope that you will be able to do
more of the things you enjoy—with far less pain.

Once you’re through reading this booklet, be sure to ask your

doctor any questions you may have. Gaining as much knowledge
as possible will help you choose the best course of treatment
to help relieve your joint pain—and get you back into the swing
of things.

Understanding the Causes of Joint Pain

What Is a Joint?

joint is formed by the ends of 2 or more bones that are

A connected by thick bands of tissue called ligaments. For
example, the knee joint is formed by the lower leg bone, called
the tibia or shinbone, and the thighbone, called the femur. The hip
joint is a ball-and-socket joint, formed by the ball, or femoral head,
at the upper end of the thighbone, and the rounded socket, or
acetabulum, in the pelvis.
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 The ends of the bone in a joint are covered with a smooth, soft
material called cartilage. Normal cartilage allows nearly friction-
less movement. The rest of the surfaces of the joint are covered
by a thin, smooth tissue lining called the synovium. The synovium
produces fluid that acts as a lubricant to reduce friction and wear
in the joint.

Common Causes of Joint Pain

One of the most common causes of joint pain is arthritis.

The most common types of arthritis are:

• Osteoarthritis (OA)—sometimes called degenerative

arthritis because it is a “wearing out” condition
involving the breakdown of cartilage in the joints.
When cartilage wears away, the bones rub against
each other, causing pain and stiffness. OA usually
occurs in people aged 50 years and older, and
frequently in individuals with a family history
of osteoarthritis.

• Rheumatoid Arthritis (RA)—produces chemical

changes in the synovium that cause it to become
thickened and inflamed. In turn, the synovial fluid
destroys cartilage. The end result is cartilage loss,
pain, and stiffness. RA affects women about
3 times more often than men, and may affect other
organs of the body.

• Post-traumatic Arthritis—may develop after an injury

to the joint in which the bone and cartilage do not
heal properly. The joint is no longer smooth and
these irregularities lead to more wear on
the joint surfaces.

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• Avascular Necrosis—can result when bone is deprived of its
normal blood supply. Without proper nutrition from the blood,
the bone’s structure weakens and may collapse and damage
the cartilage. The condition often occurs after long-term treat-
ment with cortisone or after organ transplantation.

Joint pain can also be caused by deformity or direct injury to the

joint. In some cases, joint pain is made worse by the fact that a
person will avoid using a painful joint, weakening the muscles
and making the joint even more difficult to move.

Obtaining a Quality Diagnosis

he medical management of arthritis and joint degeneration
T may be handled by a family doctor, an internist, or
a rheumatologist. However, when medical manage-
ment is not effective, an orthopaedic surgeon should
be consulted to determine if surgery is an option. In
some cases, the orthopaedic surgeon may be the first
physician to see a patient and make the diagnosis of
arthritis.

The Orthopaedic Evaluation

While every orthopaedic evaluation is different, there

are many commonly used tests that an orthopaedic surgeon may
consider in evaluating a patient’s condition.

In general, the orthopaedic evaluation usually consists of:

• A thorough medical history
• A physical examination
• X-rays
• Additional tests, as needed

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 A medical history is taken to assist the orthopaedic surgeon in
evaluating your overall health and the possible causes of your
joint pain. In addition, it will help him or her determine to what
degree your joint pain is interfering with your ability to perform
everyday activities.

What the physician sees during the physical examination, which

includes standing posture, gait analysis (watching how you
walk), sitting down, and lying down, helps confirm (or rule out)
the possible diagnosis. The physical exam will also enable the
orthopaedic surgeon to evaluate other important aspects of
your hips and legs, including:
• Size and length
• Strength
• Range of motion
• Swelling
• Reflexes
• Skin condition

If you are experiencing pain in your hip joint, your back may
be examined because hip pain may actually be the result of
problems in the lower spine.

After the physical examination, X-ray evaluation is

usually the next step in making the diagnosis. The
X-rays help show how much joint damage or deformity
exists. An abnormal X-ray may reveal:
• Narrowing of the joint space
• Cysts in the bone
• Spurs on the edge of the bone
• Areas of bony thickening called sclerosis
• Deformity or incorrect alignment
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Occasionally, additional tests may be needed to confirm the diag-
nosis. Laboratory testing of your blood, urine, or joint fluid can be
helpful in identifying specific types of arthritis
and in ruling out certain diseases. Specialized
X-rays of the back can help confirm that hip pain
isn’t being caused by a back
problem. Magnetic Resonance Imaging (MRI) or
a bone scan may be needed to determine
the condition of the bone and soft tissues of
the affected joint.

In order to assist the orthopaedic surgeon in making a diagnosis, it

may be helpful to write down your answers to the following
questions before the appointment:
• Where and when do I have pain?
• How long have I had this pain?
• Do I have any redness or swelling around my joints?
• What daily tasks are hard to do now?
• Did I ever hurt the joint or overuse it?
• Does anyone in my family have similar problems?

Treatment Options
ollowing the orthopaedic evaluation, the orthopaedic sur-
F geon will review and discuss the results with you. Based on
his or her diagnosis, your treatment options may include:
• Medication
• Physical therapy
Lifestyle Nonsurgical Surgery
• Joint fluid supplements Modifications Interventions

• Joint replacement

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 Medication
Many different medications are used to treat the pain and
stiffness of arthritis. One of the most commonly prescribed types of
drugs are the non-steroidal anti-inflammatory agents, or NSAIDs,
which can be taken long-term to reduce both the pain and swelling
caused by arthritis.

A relatively new class of anti-inflammatory drugs

called COX-2 inhibitors may provide significant
benefits in the treatment of OA. COX-2 is a protein
in the body that assists in the production of
substances that cause acute or chronic discomfort
in the joints. COX-2 inhibitors block the creation
of this protein, thus reducing inflammation in
the joints.

It should be noted that side effects involving

irritation of the stomach can occur with NSAIDs
and COX-2 inhibitors. Many people experience indigestion,
burning, or ulcer formation; in rare cases, serious stomach
problems, such as bleeding, can occur without warning.
NSAIDs and COX-2 inhibitors should not be taken by people
who are allergic to aspirin.

Another type of medication prescribed to reduce severe pain

and swelling are corticosteroids. Corticosteroid injections offer
quick, effective pain relief. However, they can be used only a few
times a year because they weaken bone and cartilage. Also, corti-
costeroids can cause other potentially serious side effects; their
use must be monitored by a physician.

Physical Therapy
Physical therapy can be helpful in the management of OA
and RA. For example, a physical therapist may recommend:
— Isometric (“pushing”) exercises to help build muscle strength
6 without subjecting inflamed joints to excessive wear
 — Isotonic (“pulling”) exercises to further increase muscle
strength and help preserve function

— Daily walking, using a cane or other assistive device

as needed

Joint Fluid Supplements

For patients whose knee joint pain does not improve with
medication or physical therapy, “joint grease” injections may pro-
vide temporary relief. The knee is injected with a joint fluid sup-
plement that acts as a lubricant for the damaged joint. Joint injec-
tion schedules and duration of relief vary according to the treat-
ment chosen and the individual patient. However, these injections
do not cure the diseased knee, and joint replacement may be
needed as the joint worsens with time.

Total Joint Replacement

Total joint replacement is usually reserved for patients who have
severe arthritic conditions. Most patients who have
artificial hip or knee joints are over 55 years of age,
but the operation is being performed in greater num-
bers on younger patients thanks to new advances in
artificial joint technology.

Circumstances vary, but generally patients are

considered for total joint replacement if:
• Functional limitations restrict not only work and
recreation, but also the ordinary activities of daily liv-
ing
• Pain is not relieved by more conservative methods of treatment,
such as those described above, by the use of a cane, and by
restricting activities
• Stiffness in the joint is significant
• X-rays show advanced arthritis or other problems
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 What Is Total Joint Replacement?
otal joint replacement is a surgical procedure in which
T certain parts of an arthritic or damaged joint, such as a
hip or knee joint, are removed and replaced with a plastic or metal
device called a prosthesis. The prosthesis is designed to enable
the artificial joint to move just like a normal, healthy joint.

Hip replacement involves replacing the femur (head of the thigh-

bone) and the acetabulum (hip socket). Typically, the
artificial ball with its stem is made of a strong metal, and the arti-
ficial socket is made of polyethylene (a durable,
wear-resistant plastic). In total knee replacement, the
artificial joint is composed of metal and polyethylene
to replace the diseased joint. The prosthesis is
anchored into place with bone cement or is covered
with an advanced material that allows bone tissue to
grow into it.

Total joint replacements of the hip and knee have

been performed since the 1960s. Today, these
procedures have been found to result in significant
restoration of function and reduction of pain in 90%
to 95% of patients. While the expected life of conventional joint
replacements is difficult to estimate, it is not unlimited. Today’s
patients can look forward to potentially benefiting from new
advances that may increase the lifetime of hip and
knee prostheses.

Recent Advances in Total Joint Replacement

early half a million hip and knee replacements are performed
N each year in the U.S. using conventional metal/plastic
prostheses. As successful as most of these procedures are,
over the years, the artificial joints can become loose and unstable,
requiring a revision (repeat) surgery.
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These issues—together with the fact that increasing numbers
of younger and more active patients are receiving total joint
replacements, and older patients are living longer—have
challenged the orthopaedic industry to try to extend the life
cycle of total joint replacements.

Recent improvements in surgical techniques and instrumentation

will help to further the success of your treatment. The availability
of advanced materials, such as titanium and ceramic prostheses
and new plastic joint liners, provides orthopaedic surgeons with
options that may help to increase the longevity of
the prosthesis.

Preparing for Joint Replacement Surgery

Preparing for a total joint replacement begins weeks before the
actual surgery date. In general, patients may be told to:

• Consider autologous blood donation—while some total

joint procedures do not require blood transfusion, it is pos-
sible that a patient may need blood during or after surgery. To
avoid using donor blood, patients may donate their own blood
ahead of time (autologous donation).
• Begin exercising under a physician’s supervision—it is
important to be in the best possible overall health to help pro-
mote the best possible surgical experience. Increasing upper
body strength is important because of the need to use a walker
or crutches after hip or knee replacement. Strengthen-ing the
lower body is also key because increasing leg strength before
surgery can reduce recovery time.
• Have a general physical examination—patients who are
considering total joint replacement should be evaluated by their
primary care physician to assess overall health and identify any
medical conditions that could interfere with
surgery or recovery.

9
 • Have a dental examination—although infections after joint
replacement are not common, an infection can occur if
bacteria enter the bloodstream. Therefore, dental procedures
such as extractions and periodontal work should be completed
before joint replacement surgery.

• Stop taking certain medications—your orthopaedic surgeon can

advise you which over-the-counter and prescription medications
should not be taken before surgery.

• Stop smoking—a good idea at any time, but particu-

larly before major surgery in order to help reduce the
risk of post-operative lung problems and improve
healing.

• Lose weight—in patients who are obese, losing

weight will help reduce stress on the new joint.

• Arrange a pre-op visit—an important opportunity to

meet with healthcare professionals at the hospital to
discuss your personal hospital care plan, including
anesthesia, preventing complications, pain control,
and diet.

• Have routine laboratory tests—blood tests, urine tests, an EKG

or cardiogram, and chest X-ray may be prescribed to confirm
that you are fit for surgery.

• Evaluate post-surgical needs for at-home care—every patient

who undergoes total joint replacement will need help at home for
the first few weeks, including assistance with preparing meals
and transportation.

Preventing Possible Complications

of Surgery
he complication rate following joint replacement surgery

10
T is very low. Serious complications, such as joint infection,
occur in less than 2% of patients. Nevertheless, as with any
major surgical procedure, patients who undergo total joint
replacement are at risk for certain complications—the vast major-
ity of which can be successfully avoided and/or treated. Possible
complications include:

Infection
Infection may occur in the wound or within the area around
the new joint. It can occur in the hospital, after the patient returns
home, or years later. Following surgery, joint replacement
patients receive antibiotics to help prevent infection.
For the rest of their lives, they may also need to take
antibiotics before undergoing even minor medical
procedures to reduce the chance of infection
spreading to the artificial joint.

Blood Clots
Blood clots can result from several factors, including
the patient’s decreased mobility following surgery,
which slows the movement of the blood. There are a
number of ways to reduce the possibility of blood clots,
including:
• Blood thinning medications (anticoagulants)

• Elastic support stockings that improve blood

circulation in the legs

• Plastic boots that inflate with air to promote blood flow

in the legs

• Elevating the feet and legs to keep blood from pooling

• Walking hourly

Lung Congestion
Pneumonia is always a risk following major surgery. To help keep
the lungs clear of congestion, patients are assigned a series of
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deep breathing exercises.
 What to Expect the Day of Surgery
very hospital has its own particular procedures, but total
E joint replacement patients can expect their day-of-surgery
experience to follow this basic routine:
• Arrive at the hospital at the appointed time

• Complete the admission process

• Final pre-surgery assessment of vital signs and general health

• Final meeting with anesthesiologist and operating

room nurse

• Start IV (intravenous) catheter for administration of fluids and

antibiotics

• Transportation to the operating room

• Joint replacement surgery—generally lasts 1 to 2 hours

• Transportation to a recovery room

• Ongoing monitoring of vital signs until condition is stabilized

• Transportation to individual hospital room

• Ongoing monitoring of vital signs and surgical dressing

• Orientation to hospital routine

• Evaluation by physical therapist

• Diet of clear liquids or soft foods, as tolerated

• Begin post-op activities taught during pre-op visit

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In the days following surgery, your condition and progress will
continue to be closely monitored by your orthopaedic surgeon,
nurses, and physical therapists. Much time will be given to exer-
cising the new joint, as well as deep breathing exercises to
prevent lung congestion. Estimated Recovery Schedule
Gradually, pain medication
will be reduced, the IV will be
Significant
removed, diet will progress to In-hospital functional improve- Maximal
solid food, and you will become recovery ment improvement
2 – 5 days 6 weeks – 6 – 12 months
increasingly mobile. 3 months

Joint replacement patients are

generally discharged from the
hospital when they are able to achieve certain rehabilitative mile-
stones, such as getting in and out of bed unassisted or walking
100 feet. Whether you are sent directly home or to a facility that
assists in rehabilitation will depend on your physician’s assess-
ment of your abilities.

Getting Moving Again

t may come as a surprise to you that total joint
I replacement patients are encouraged to get up and start
moving around as soon as possible after surgery—as early as
the day of surgery.

When you are medically stable, the physical therapist

will recommend certain exercises for the affected joint.
Physical therapy is a key part of recovery. The more
quickly a joint replacement patient gets moving again,
it is likely the more quickly he or she will regain independ-
ence. To ease the discomfort the activity will initially cause,
pain medication is recommended prior to therapy. In addi-
tion, the physical therapist will discuss plans for rehabili-
tation following hospital discharge.

13
 Depending on your limitations, an occupational therapist may
provide instruction on how to use certain devices that assist in
performing daily activities, such as putting on socks, reaching for
household items, and bathing. A case manager will discuss plans
for your return home and will ensure that you have all the neces-
sary help to support a successful recovery. If needed, the case
manager can help arrange a home therapist.

Life After Total Joint Replacement

he vast majority of individuals who have joint
T replacement surgery experience a dramatic
reduction in joint pain and a significant improvement
in their ability to participate in the activities of daily liv-
ing. However, joint replacement surgery will not allow
you to do more than you could before joint problems
developed. Each patient’s physician will recommend
the most appropriate level of activity
following joint replacement surgery.

In the weeks following total joint replacement, certain

limitations are placed on every patient’s activities. Using a cane
or walker may be necessary for several weeks. Kneeling, bending,
and jumping will likely be forbidden for the first month. It
may be 6 weeks before driving is permitted. The orthopaedic
surgeon and physical therapist will provide specific
recommendations.

When fully recovered, most patients can return to work,

although some types of work—such as construction work,
certain types of carpentry, and occupations that involve repeated or
high climbing—may not be advisable for individuals with a joint
replacement. Also, athletic activities that place excessive stress
on the joint replacement, such as skiing, basketball,
baseball, contact sports, distance running, and frequent
jumping, should be avoided.
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After joint replacement, a good rule of thumb is that acceptable
physical activities should:
• Not cause pain, including pain felt later
• Not jar the joint, as happens with running or jumping
• Not place the joint in the extremes of its range of motion
• Be pleasurable
It is also important for an individual with a joint replace-
ment to keep his or her body weight as close
to normal as possible. Joint wear and loosening increas-
es with weight increase.

Talk to Your Doctor

ou don’t have to live with severe joint pain and the
Y functional limitations it causes! Even if you have not
experienced adequate results with medication and other
conservative treatments, total joint replacement may
provide the pain relief you long for—and the resulting
return to your favorite activities.

Use the space at the end of this booklet to write down

a list of questions about your condition, your concerns, and the
ways that total joint replacement might benefit you. Then make
an appointment to talk to your doctor—and make note of his or
her answers and recommendations.

Remember, even if your orthopaedic surgeon determines that

joint replacement is a good medical option for you, it is still up to
you to make the final decision. The ultimate goal is for you to be
as comfortable as possible…and that always means 1 making the
best decision for you based on your own individual needs.

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Questions for My Doctor
 Howmedica Osteonics is a global leader in the

reconstructive orthopaedic device business

with our products and services being marketed
in more than 40 countries worldwide. We are

dedicated to the research, development and

manufacturing of leading-edge products such as total hip, total knee, upper
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