Arthritis of the knees, hips and, to a much lesser extent, the ankles is a common problem that can be disabling if it prevents us from walking. Inability to get around is a difficulty for many frail elderly people, and arthritis is one of the major causes.
If a hip or a knee is painful, there are a few things you can do.
The first is to lose weight. Consider this analogy: Imagine the damage that a 5-foot-6-inch, 75-year-old woman who weighs 140 pounds would suffer if she were required to carry 50 pounds of bricks on her back wherever she went. It would be substantial. That's exactly what many 5-foot-6-inch, 190-pound people are doing to themselves because of their inability to lose weight.
A second is medication. Unfortunately, the choices are limited. There are the "arthritis medicines," including aspirin and its many cousins (Voltaren, Naprosyn, Feldene, Motrin). These powerful drugs can usually relieve pain, but they don't affect the underlying damage to the joint. Furthermore, they have many serious side effects, such as bleeding ulcers and kidney failure.
Next is the family of narcotic pain relievers, beginning with codeine and Darvon and continuing through to morphine. The drawback of narcotics should be obvious. Finally, there is acetaminophen. I believe this is the safest, but it's not as strong a pain reliever as the others.
None of these drugs does your joints any good. The drugs simply reduce the amount of pain you feel.
Rest and gentle exercise are probably good for most joints, unless you're overweight. Applying mild heat and using a cane are also probably beneficial. Vitamins and copper bracelets are simply expensive placebos.
The final option for this arthritis is a major surgical procedure known as total hip replacement. In this procedure the ball-and-socket hip joint is completely replaced with a synthetic one.
The "ball" in this case is the femoral head at the top of your thigh bone. It fits into a "socket" in your pelvis, known as the acetabulum. (Contrary to popular melodies, there is no hip bone; the hip is a joint between the femur and pelvis.)
The reasons to think about total hip replacement are simple. If you have hip pain that prevents you from being as mobile as you'd like, and nothing else is relieving the pain, hip replacement is a possibility.
The operation is better for older people, because they are apt to be less active, and thus less likely, to wear out their joint. If they do survive longer than their artificial joint, they also can have further surgery. People who are heavy enough to have destroyed the hip joints provided by Mother Nature will probably be as hard on artificial hips unless they lose weight.
A total hip replacement is, like all major surgery, somewhat dangerous. It's also quite expensive. But if it permits a person to begin walking again, then some risk and cost are justifiable. I do consider this procedure to be a last resort.
Dr. Finucane is in the Division of Geriatric Medicine at the Francis Scott Key Medical Center.