For people whose osteoarthritis has progressed to the point that it prevents them from participating fully in life, joint-replacement surgery can be an excellent option to restore mobility. But it's not for everyone. To begin with, it's not meant to substitute for lifestyle changes. "We're still going to tell you to achieve a healthy weight and exercise as a way to protect the new joint," says Joseph D. Zuckerman, M.D., chair of the department of orthopaedic surgery at the NYU Langone Medical Center. Younger patients also need to consider the 10- to 20-year life span of artificial joints. And you must be prepared for the risks of major surgery, as well as a lengthy recovery period and substantial physical therapy.
Making a decision
Health-care researchers use what they call "decision aids" to help patients explore their options. These booklets, DVDs, or Web videos provide evidence-based information in plain language so that you can have an informed conversation with your doctor and reach a decision that takes into account your needs and preferences.
"Decision aids help you weigh risks and benefits and, with your provider's help, come to a conclusion about what treatment option is right for you," says David Arterburn, M.D., M.P.H., an associate investigator with Group Health Research Institute, the research arm of a nonprofit health-care system in Washington and Idaho.
Arterburn was the lead author of a study published in September 2012 that compared six-month outcomes for about 9,500 patients with knee or hip osteoarthritis before and after the providers introduced video and written decision aids. It found that the number of knee replacements dropped by 38 percent after patients started using the aids; hip replacements fell by 26 percent. And patient satisfaction increased, regardless of what treatment they chose.
Finding an aid
If your doctor doesn't provide decision aids, you can access the one used in the Group Health study, created by the company Health Dialog. For other aids, make sure the information comes from a reputable, impartial source—such as an academic research center or government agency—and not, say, a company that makes artificial joints, which probably has a vested interest in the outcome.
You should also discuss your decision with a provider other than your orthopaedic specialist, who may be more biased toward a surgical fix, Arterburn says. Your primary-care doctor is a good place to start.