Updated September 03, 2013.

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Question: Danger in Delaying Joint Replacement Surgery?

Have you been told you need joint replacement surgery, but had hoped you could wait a little longer? Well, you're not alone. Many patients want to find relief from pain, but are not ready to proceed with a major surgery. They may therefore choose to delay joint replacement and continue simpler treatments, including oral medications, cortisone injections, use of walking aids, and physical therapy.

But they may also worry...am I doing damage, or making surgery more difficult, by delaying a hip or knee replacement?

Answer:

In the short term, the answer is no. Seldom does surgery get more complicated or more difficult because of a delay in joint replacement surgery. Patients who are diagnosed with hip arthritis or knee arthritis should take time to determine the right course of treatment for their situation. This may include trying more simple treatments, getting another opinion, or taking some time to consider their options.

But there are some considerations patients should understand. While delaying surgery for months, or even years, may not have significant consequences, prolonged delay may complicate their situation. Here are some of the concerns about delaying joint replacement surgery:

• Worsening of Joint Deformity
  Most often arthritis progression is gradual, and develops slowly over the course of months and years. Some people do have accelerated changes, but even in these situations the changes don't occur overnight.
  As arthritis worsens, there can be increasing deformity of the joint. In patients with knee arthritis, this most commonly becomes an increasing knock-kneed or bow-legged deformity. In hip arthritis, the leg length can shorten as cartilage and bone wears away. Joint replacement can become more complicated with increasing deformity of the joint. This may require your surgeon to use specialized implants or perform more extensive surgery to correct the deformity.
  

• Stiffness of Joint
  In the same light, as joint arthritis progresses, the joint moves less. With less movement, soft-tissues surrounding the joint — including muscle, ligaments and joint capsule — may contract, causing stiffness. This is especially notable for patients having knee replacement, where mobility before surgery is one of the best indicators of expected motion after surgery.
• Strength of Muscles
  As arthritis progresses, muscles surrounding the joint are likely to weaken. People use the joint less, and limit their physical exertion as a result of their pain. As the muscles weaken, rehabilitation after surgery may become more difficult, and perhaps the muscles may never regain their full strength.
• Compensatory Issues and Problems
  This is probably the most controversial complication of delaying surgery, as there is debate about the extent to which the body develops this type of compensatory problem. But it's reasonable to believe that people who favor one joint may place more of a burden on other parts of the body. People with severe hip arthritis often experience back pain, and people with knee arthritis often complain of pain in their opposite knee.
• General Medical Health
  Your surgeon can usually overcome the technical difficulty of performing joint replacement on someone who has delayed her surgery, but there can be patients who develop medical problems as a result of aging and decreased physical activity. Weight gain, decreased endurance, cardiac and pulmonary conditions are all concerns for people who put off joint replacement for too long.

These are some of the reasons that you may want to proceed with joint replacement surgery. As stated, seldom are any of these issues acute emergencies — meaning you certainly have time to make a decision that works for you. I often hear doctors say, "you'll know when the time is right to proceed with surgery." I don't think this is a terribly helpful thing to say; rather, I would encourage you to think about the signs you're ready for knee replacement or hip replacement, and use these as your guide for determining when to proceed with surgery.
<sub>Source:

Poss R, "Total Joint Replacement: Optimizing Patient Expectations" J. Am. Acad. Ortho. Surg., Oct 1993; 1: 18 - 23.</sub>