When it's time to replace a damaged joint

Waiting until arthritis damage is severe can make surgery harder and full recovery less likely. Check the list below to see if it's time to talk with an orthopedic surgeon about joint replacement.

• Medication doesn't relieve the pain or produces unacceptable side effects.
  
  
• The pain makes it hard to sleep.
  
  
• You have trouble with routine movement, such as bathing, climbing stairs, or getting out of a chair.
  
  
• The pain interferes with your lifestyle by, for example, making it difficult to exercise, shop, or visit friends.
  
  

More Americans than ever are walking around with artificial hips and knees, and aging baby boomers are leading the way. That's partly because excess weight is fraying their joints earlier. Between 2000 and 2006, knee replacements shot up by 65 percent, and a growing number of patients were under age 65, according to the National Center for Health Statistics. And the numbers may grow. Nearly one in two adults—and two-thirds of obese adults—will develop painful knee arthritis, researchers estimate.

Hip and knee replacements get high marks for relieving arthritis pain. Though the procedures can have serious complications and don't always restore perfect mobility, more than 80 percent of people said they were "very" or "completely" satisfied with their new joints, according to a Consumer Reports survey of 1,000 patients who had the surgery between 2000 and 2004. And since then, advances in pain control and rehabilitation have sped recovery.

But the increase in younger patients, who will eventually outlive their artificial joints, poses challenges. Manufacturers have responded with new implants that last longer in the laboratory than traditional ones, but none of them has been tested long enough to know how they will perform beyond 10 or 20 years in real life. Yet the implants, as well as several controversial surgical procedures, have been heavily advertised to consumers and rapidly accepted into practice. "Physicians feel that if they don't jump on this technology bandwagon, they'll be left behind the rest of the pack," says Matthew Kraay, M.D., professor of orthopaedic surgery at the Case Western Reserve University School of Medicine in Cleveland. "They don't have an opportunity to wait for the peer-reviewed result."

But early reports are trickling in. The following guide will help you weigh the pros and cons of current options in hip and knee surgery.

This article first appeared in the February 2009 issue of Consumer Reports on Health.