David Ayers

November 2009

“I’m not going to live like this.” That’s what David Ayers told himself when the pain in both his hips became more frequent, until it was every day. The pain got so bad it ended his ability to enjoy the activities he loved the most.

So he went to a specialist who took X-rays and showed him how his hips were rubbing bone against bone, the protective cartilage worn down to literally nothing. To relieve the pain, Ayers started on cortisone injections, which worked for a while, but not long enough. That’s when his doctor, orthopedic surgeon Dr. Frank Ennis, suggested hip replacement.

It’s about your pain, not your age
Once he decided to go ahead with the procedure, Ayers attended a pre-surgery class at Greenwich Hospital to find out what he should expect with the surgery and the rehab afterward. He felt like he was one of the younger people in his class, but his surgeon, Dr. Ennis, said that people going in for joint replacement of their knees or hips today span a wide age range. Some as young as 30 might have a congenital condition, for example. Or they might have suffered significant trauma to their joints.

“Deciding on whether or not to go for joint replacement is no longer about age,” explained Dr. Ennis. “If you’re in the prime of your life, you should enjoy it. There’s a quality of life you should experience.” Dr. Ennis also sees patients in their 90s with arthritis that is so bad they are essentially confined to a wheelchair.

Ayers, an active 64-year-old, underwent surgery in October 2007 to have the ball of his right hip replaced, then went through the same procedure a few months later on his left hip. Today, he’s back in action, playing golf and working out at the gym.

Exploring the options
Surgery is never the first step to relieve pain, and many people put it off. But waiting until the pain becomes disabling is not a good idea, according to Dr. Ennis.

“First, we can work with a patient to modify activity by trading in high-impact sports like tennis for sports with less impact on the joints. I encourage patients to exercise to strengthen muscles around the joints, and weight loss is highly recommended for some patients. Extra weight puts more pressure on the joints.”

Medications sometimes solve the problem. “Anti-inflammatory medications can be effective to reduce pain, but you have to think about long-term side effects.

Cortisone is a very powerful pain reliever, but relief from cortisone injections varies from patient to patient. Because of the effect of cortisone on the remaining cartilage, most doctors only like to inject cortisone into a joint three or four times,” said Dr. Ennis.

The FDA has approved new injectable medications for knee pain that lubricate the cartilage with nutrients. This seems to work when arthritis is mild, but when you’ve tried these stopgap measures and the pain returns again and again, joint replacement becomes the permanent solution.

The newest technology
The procedure for replacing worn-out knees and hips with brand new ones has changed significantly in the last ten years. The surgery is less invasive, making recovery quicker and easier. Plus, the technology has evolved so the implants are better adapted to more precisely fit a patient’s anatomy, and they last longer, too.

“It’s not so much about the size of the incision of the skin, but about what we do underneath the skin,” explained Dr. Ennis. He, like many other surgeons, now maps the joint using a highly precise computerized image guidance system that allows him to see beyond what is possible with the naked eye. With infrared cameras and digitized images, every aspect of the operation is tracked by computer, including the surgical instrumentation. This way, there is less interruption to the tendons and tissues around the joint. Computers also help the doctor to precisely position the implant. The more precise the alignment, the better the range of motion for the patient.

Did these advancements make recovery easier for David Ayers? “You bet,” he says. “The very next day, I was walking with a walker. Within a week, I was using a cane and going up and down stairs.”

Within one month of his surgery, Ayers was driving, and in four months he was back on the golf course. Even so, at 64 and pain-free, he says he’s slowing down. “I was big into sports in college, played a lot of tennis, did a lot of sailing and have always enjoyed bike riding,” he says. “I’ve given up downhill skiing now because I won’t ski timid, and I don’t want to wipe out on my hips. But that’s okay. Now I stick to lower impact sports like golf and swimming. I read more when on vacation. All in all, my life is back to where it was.”

Rehabilitation – an important step
The fact that David healed so quickly is not a surprise to Dr. Ennis, acknowledging the fact that the post-surgery rehabilitation is more grueling than the surgery itself.

“I find that athletic and active people do well with the rehabilitation because they are used to pushing through physical discomfort to reach a goal.” Someone who’s a couch potato may have to find a new mindset as they strengthen their muscles around the new joint. “Attitude is very important, and so is the quality of your rehab experience,” Dr. Ennis continues. “You want to select an inpatient rehab facility that handles a lot of joint replacement patients. Once you’re home, the next phase involves continuation of rehabilitation and physical therapy on an outpatient basis. Again, you’ll want to choose a facility that works with a lot of joint replacement patients, and is also conveniently located so you can easily get there at least three times each week.”

Joint replacement is a big step. So how do you know if it’s time to consider this procedure for yourself? Dr. Ennis says, “When pain affects your quality of life and your ability to function, if you think twice about taking the stairs because it hurts, or if chronic pain is starting to affect the overall way you approach life and your daily activities, it’s time to give it a serious look.”