Joint replacement surgery is a major surgery.  Many people want to put it off as long as possible in hopes that they can adequately manage their symptoms without this major intervention.

But I also hear concerns about delaying joint replacement surgery.  So what should you do?  Are there dangers in putting things off?  Learn about delaying  joint replacement surgery and what you should think about when determining if the time is right for you.

The purpose of performing knee replacement surgery is to allow for activity.  For many people, this means the ability to do sports and recreational activities that they enjoy.  But people undergoing knee replacement also want to ensure the implant lasts a long time.  Therefore, it is important to limit activities that may damage the implanted joint.

So what should a patient do?  Most listen to their doctor, but most doctors rely on very little data to guide their patients on which activities they should and shouldn't do.  A group of patients in California recently had special knee implants with pressure sensors imbedded in the replacement placed in their knees.  Researchers then had these patients do activities, and tested the stress on the implanted knee joint.

The findings demonstrate some of what we expected: the best activities that place little stress on the joint include cycling and rowing.  Activities including skiing and jogging placed high stress on the joint.  Somewhat surprisingly, the golf swing places as much force as jogging, especially on the leading knee.

Golfers need not give up hope.  The researchers note that unlike jogging, which places many repeated stresses on the implant, the golf swing creates this stress only once per swing.  So the number of stressful events on the implanted joint is much smaller for a round of golf that even a short run.

Patients need to make their own decisions, but they need to be guided by the best available data to understand the issues.  Many patients wrote angry responses when I suggested a few years ago that golf may not be ideal for a replaced knee.  My point is simply that I think patients should be aware of the best information available to make appropriate medical decisions.  I understand that many doctors say that golf is fine for a knee replacement, however, the data may suggest otherwise.

Source: In Vivo Knee Forces During Recreation and Exercise After Knee Arthroplasty

People often say their knees are arthritic because of activity. It is a typical story to hear that a patient associates their arthritis with the fact that they have been physically active.

The truth is that knees are almost always helped by physical activity. In fact, patients who have participated in vigorous physical activity have better, healthier cartilage than patients who are not physically active. Furthermore, patients who are physically active have less of a chance of being obese, have stronger muscles, and are less likely to experience knee pain.

What does this mean for you? If you have good knees, then vigorous physical activity will help to maintain your knee health--not hurt your knees.

Related: Knee Arthritis | Ready for knee replacement?

Sources: Racunica TL, et al. "Effect of physical activity on articular knee joint structures in community-based adults" Arthritis Rheum. 2007 Oct 15;57(7):1261-8.

A new study has investigated the use of ice and heat application, and determined the use of either treatment helped, but it didn't matter which was used.  Many doctors tell patients to use ice at one time, heat at another, but for acute low back strain injuries, the choice didn't seem to matter.

This study looked at patients who came to the emergency room after a back injury.  All patients received oral anti-inflammatory medications, and then the patients were either given an ice pack or a heat pad, and this was applied to their back.  The study researches then looked at how their pain changed.  They found that ice or heat, it didn't seem to matter.

Bottom Line: Study authors recommended that patients or providers use either ice or heat, whatever their preference.  So if you have back pain, and one feels more comfortable, then pick that treatment.

_{Sources: Garra G, et al. "Heat or Cold Packs for Neck and Back Strain: A Randomized Controlled Trial of Efficacy" Academic Emergency Medicine; Volume 17 Issue 5, Pages 484 - 489.}

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